Message to the Community
I am pleased to present the 2014-2019 Dakota County Community Health
Improvement Plan. The plan is a combined effort by the Public Health Department and our
many community partners. Special thanks to the Healthy Dakota Initiative steering committee
for their excellent input and guidance.
The Community Health Improvement Plan includes goals, measurable objectives and action
steps for the two priority planning areas identified by the Healthy Dakota Initiative: promoting
mental health and reducing obesity by increasing physical activity and improving eating habits.
The plan is intended to be a call to action and a guide for community stakeholders to improving
health in Dakota County.
We look forward to working with you on implementing the plan to improve community health
in Dakota County.
Healthy regards,
Bonnie Brueshoff
Public Health Director, Dakota County Public Health Department
About this report
The Dakota County Community Health Improvement Plan is a key step in a long-term, systematic effort
to address public health issues identified in the community health assessment. This report and the
Dakota County Community Health Assessment are posted on the Dakota County website at: Dakota
County Community Health Assessment
For additional information, please contact Melanie Countryman, Public Health Epidemiologist by e-mail
([email protected]) or by phone (651-554-6131).
Original publication date: August 25, 2014
Dakota County Community Health Improvement Plan, 2014-2019
Table of Contents
Executive Summary......................................................................................................................... 3
County Description ......................................................................................................................... 4
Planning Process ............................................................................................................................. 4
Document Format ......................................................................................................................... 10
Priority 1: Physical Activity/Eating Habits/Obesity ....................................................................... 11
Priority 2: Mental Illnesses/Promoting Mental Health................................................................. 19
Definitions ..................................................................................................................................... 26
Dakota County Healthy Dakota Initiative Collaborating Organizations ....................................... 29
Acknowledgments......................................................................................................................... 30
References .................................................................................................................................... 32
Appendix A – Community Strengths ............................................................................................. 35
Appendix B – Forces of Change .................................................................................................... 36
Appendix C – Revision History ...................................................................................................... 39
Vision:
Health and well-being for all in Dakota County
Values:
•
•
•
Strong community connections promote optimum well-being.
Individuals, families, groups and organizations actively participate in creating a healthy
community
All who live or work in Dakota County – regardless of age, gender, race, ethnicity, or
socioeconomic status – have multiple opportunities to maximize their health.
Dakota County Community Health Improvement Plan, 2014-2019
2
Executive Summary
The Healthy Dakota Initiative is a comprehensive community health assessment and
improvement project initiated in April 2013. The Healthy Dakota Initiative Steering Committee
includes representatives from a broad cross-section of partner organizations, including
hospitals, clinics, schools, non-profits, and businesses, as well as community members from the
Dakota County Human Services Advisory Committee (HSAC). The Healthy Dakota Initiative aims
to engage the community in a strategic planning process to improve the health and safety of all
Dakota County residents, and to ensure that the priorities and strategies are shared by the
partners in the county. The Dakota County Community Health Assessment represented the first
step in the planning process. In addition to information about the health of the community, the
Community Health Assessment includes information about assets, challenges, barriers, and
resources that the Healthy Dakota Initiative Steering Committee used to develop the Dakota
County Community Health Improvement Plan (CHIP).
Dakota County Public Health Department convened, facilitated and participated in the CHIP
process. Based on the data from the Community Health Assessment, the Healthy Dakota
Initiative Steering Committee identified two priority areas for the CHIP:
Mental illnesses/promoting mental health
Improve mental health and prevent mental illnesses by identifying needs, providing education,
and promoting access to mental health services for all residents of Dakota County.
Physical activity/eating habits/obesity
Reduce chronic disease, health disparities, and health care costs by creating sustainable policy,
system, and environmental changes that increase access to healthy food, increase
opportunities to be physically active, and increase breastfeeding support.
In addition, the committee decided to address healthy start for children and adolescents
and health equity across both of these priority areas.
Action teams of community partners were formed for the two priority areas to identify goals,
measureable objectives and strategies. The action teams are committed to implementation,
evaluation, and reporting to the community and stakeholders.
Dakota County residents and community leaders are encouraged to use this plan as a resource
and a call to action.
Dakota County Community Health Improvement Plan, 2014-2019
3
County Description
Dakota County is the third most populous county in Minnesota, comprising 7.5 percent of the
population of Minnesota (1). It is located in the southeast corner of the Twin Cities
Metropolitan area and encompasses 587 square miles, 562 square miles in land and 25 square
miles in water (2). Two major rivers, the Mississippi and the Minnesota, form the county’s
northern and eastern borders. The county shares borders with the following counties:
Hennepin County in the northwest, Scott County in the west, Rice County in the southwest,
Ramsey County in the north, Washington County in the northeast, Pierce County, Wisconsin in
the east, and Goodhue County in the southeast (3).
Geographically, Dakota County is largely rural; however, the county maintains an equal land use
mix of urban, suburban and rural (3). Nearly 80 percent of the county’s population resides in
the northern and northwestern portions of the county (4).
 Dakota County had an estimated 405,088 residents in 2012 (1).
 Dakota County is divided into 21 incorporated municipalities. A small portion of Hastings
is in Washington County and the majority of Northfield is in Rice County (5).
 The five largest cities are: Eagan (64,206), Burnsville (60,306), Lakeville (55,954), Apple
Valley (49,084), and Inver Grove Heights (33,880), which comprise 66 percent of the
population of the county (4). Eagan is also the ninth largest city in Minnesota (6).
Planning Process
Process used by the Healthy Dakota Initiative
The Healthy Dakota Initiative adapted components of the Mobilizing for Action through
Partnerships and Planning (MAPP) model to collect data that was used to develop community
health improvement strategies. MAPP is a strategic planning process used by communities to
collect and analyze data, prioritize issues, identify resources to address priorities, and develop
goals and strategies. It was jointly developed by the National Association of City and County
Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) (7).
Dakota County Community Health Improvement Plan, 2014-2019
4
Determining community health priorities
The Healthy Dakota Initiative Steering Committee reviewed findings from the Community
Health Assessment and considered input collected during the public comment period. The
committee went through a multi-step process to identify priorities. In the first step, 12
priorities were evaluated on four dimensions: extent (e.g., groups at risk and number of people
affected), seriousness (e.g., urgency of health problem, public concern, potential for long-term
illness or disability, economic impact), gap in resources available (e.g., gaps or limitations in
service or location of services, impact of lack of services on the community), and health
disparities (e.g., differences in impact on various groups). As a result of that evaluation, ten
issues were identified as top health priorities in Dakota County:

Mental Illness: More than 26 percent of adults in the U.S. suffer from a mental disorder
in any given year, with nearly six percent experiencing a severe mental illness. Mental
health disorders are the leading cause of disability in the U.S. for 15-44 year olds (8).
According to the U.S. Surgeon General, a range of effective treatments exist for most
mental disorders, yet nearly half of all Americans who have a severe mental illness fail
to seek treatment. Good mental health is essential to leading a healthy life.

Physical activity/eating habits/obesity: Unhealthy eating, along with physical inactivity,
is one of the most important risk factors for chronic disease in the United States. A study
in 2000 estimated that 400,000 deaths annually could be attributed to poor diet and
physical inactivity (9). Unhealthy eating, combined with physical inactivity, contributes
to the development of obesity and chronic diseases, such as heart disease, stroke, type
2 diabetes, high blood pressure, osteoporosis and certain cancers. According to the
Centers for Disease Control and Prevention, since the late 1970s, the prevalence of
overweight and obesity in the United States has nearly doubled in adults, more than
doubled in children and more than tripled in adolescents.
Dakota County Community Health Improvement Plan, 2014-2019
5
Determining community health priorities (continued)

Use of alcohol, tobacco, and other drugs: The misuse of alcohol and other drugs are
important risk factors for chronic disease, death and disability in the United States. An
estimated 79,000 deaths annually in the U.S. can be attributed to excessive alcohol use
(10). Alcohol and illicit drug use are associated with unintentional injuries, violence, risky
sexual behavior, and illegal behavior, and can lead to liver disease, cancer, heart
disease, and neurological and psychiatric problems. Children exposed to alcohol or
other drugs during pregnancy can suffer lifelong physical and mental disabilities. Use of
alcohol or illicit drugs can lead to dependence in some people, which increases the risk
of harmful consequences. Tobacco use is the single most preventable cause of disease,
disability, and death in the United States, with an estimated 480,000 people dying each
year from tobacco-related illness (11). Cigarette smoking is associated with cancer,
emphysema, chronic bronchitis, heart disease, and stroke. In addition, there are health
effects for non-smokers who are exposed to secondhand smoke, including an increased
risk of dying from lung cancer or heart disease, and children are at increased risk of
sudden infant death syndrome (SIDS), ear infections and asthma. Mothers who smoke
cigarettes during pregnancy are at risk for poor birth outcomes, such as preterm birth,
low birth weight, and stillbirth.

Promoting mental health: According to the World Health Organization definition,
mental health is “... a state of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work productively and fruitfully,
and is able to make a contribution to his or her community.” Mental health is the basis
for well-being and function of the individual and the community. Mental health, social
conditions, and health behaviors may interact to intensify the effects on overall health
of individuals.

Public health funding: Adequate public health funding is necessary in order to maintain
the infrastructure to keep the public healthy. Public health infrastructure refers to all
aspects of the public health system that help health professionals carry out essential
public health services to promote, protect and maintain the health of the community as
a whole. Examples are: workforce capacity and competency, information and data
systems, and organizational and systems capacity. It includes activities that are required
by law, efforts to assure the delivery of public health services to diverse populations,
and actions that help maintain the public health system.
Dakota County Community Health Improvement Plan, 2014-2019
6
Determining community health priorities (continued)

Preventing/management of chronic conditions: The leading causes of morbidity and
mortality in Dakota County include preventable chronic diseases such as cancer,
cardiovascular disease, stroke, and diabetes. In addition, the long course of illness for
some chronic diseases results in activity limitations and pain, decreasing the quality of
life for many county residents.

Income/poverty/employment: The economic conditions in which people live and work
can influence health and life expectancy. These conditions can affect a person’s life and
work conditions, such as stress levels, access to healthy food, safe places to exercise,
exposure to environmental hazards, and availability of early learning opportunities.
These exposures interact to increase or decrease the risk for many major diseases, such
as heart disease, stroke and Type 2 diabetes.

Healthy start for children and adolescents: The health of mothers, infants, and children
is important for the health of the current generation and future generations. Healthy
growth and development of infants depends on the health of the mother before
conception and the health and safety of mother and infant during delivery. A positive,
supportive environment for mother and infant following birth is also critical.

Access to health care: Ability to access health care is affected by insurance coverage,
cost, language and cultural barriers, availability of providers, and transportation. People
who are not able to access health care are at increased risk for serious medical
problems, premature mortality and poor health outcomes. Inability to access health
care often results in receiving medical treatment later in the course of illness and in
more costly settings, which increases the financial burden on the health care system.

Affordable housing: Affordable housing is an important factor in both physical and
mental health. Home ownership provides financial stability and control over the living
environment. Home owners are more likely to be involved in the life of the community.
Excessive housing costs limit the amount of funds available for other needs, such as
food and medical care. It also results in elevated stress levels that have an impact on
health. When housing is affordable, people do not have to move as frequently.
Children who have a stable living environment have higher academic achievement and
better health outcomes.
Dakota County Community Health Improvement Plan, 2014-2019
7
The second step was to identify the priorities that would be incorporated into the Community
Health Improvement Plan. To prepare for this step, the committee reviewed potential
interventions from state and national frameworks, as well as an inventory of activities that
were already occurring in the county related to the ten health concerns. The committee then
evaluated the ten health priorities on three dimensions: seriousness of the problem, existence
of effective interventions, and practicality of implementing the interventions. The evaluation
produced two planning priorities: mental illnesses/promoting mental health and physical
activity/eating habits/obesity.
The committee also noted that two other highly-rated concerns, healthy start for children and
adolescents and health equity, cut across both of the priority areas, and the group encouraged
the action teams to develop strategies that address these issues.
Action teams of community partners were formed to identify goals, measureable objectives
and strategies for the two priority areas. The action teams will continue to be part of the
implementation of the plan, and will regularly review progress, performance measures, and
plan updates.
Framework for community health improvement planning
In developing the Dakota County Community Health Improvement Plan, the ideas from two
frameworks were incorporated: 1) Healthy Minnesota 2020 and 2) Healthy People 2020.
Healthy Minnesota 2020 is the statewide framework for improving health in Minnesota.
Healthy People 2020 establishes 10-year, national benchmarks for improving health of all
Americans. Both are based on the principle that health is the product of many factors, from
individual biology to community and system health. These factors create the conditions that
allow people to be healthy (12; 13).
Dakota County Community Health Improvement Plan, 2014-2019
8
Implementation and monitoring of plan
Below is the implementation timeline for the first year:
September 2014
 Present CHIP to Community Health Board
 Action teams develop work plans
October 2014
 Start CHIP implementation
December 2015
 Complete first annual report on CHIP
Information will be collected on a quarterly basis in order to update the Dakota County Public
Health tracking tool. The action teams have committed to developing annual work plans, and
to meet at least twice per year to review the progress of each objective. At these meetings,
community partners will give updates on their activities and discuss any barriers or changes
that need to be made. Once a year, action team members will review progress and available
measurement data on each objective. Based on this review, the action team may recommend
quality improvement projects or revisions to the plan. Plan revisions will be decided by
consensus of the appropriate action team and will be based on the following criteria:
 Feasibility of the strategy (if not started)
 Effectiveness of the strategy
 New or emerging health issue
 Strategy completed
 Change in health status indicators
 Change in level of resources available
Note: The activities under the Obesity priority are funded by the Statewide Health
Improvement Partnership grant, which is on a 2-year cycle. The interventions are prescribed by
the grant and the work plan is set for the 2-year period, so the action team is not able to
recommend plan revisions during the 2-year period of the grant. Therefore, annual discussions
will be limited to progress on strategies, changes in level of resources, and recommendations
for future grant cycles.
An annual report will be completed by the end of December each year that details the progress
and future plans for each of the objectives.
Dakota County Community Health Improvement Plan, 2014-2019
9
Document Format
This document is organized by the two priority areas: physical activity/eating habits/obesity and
mental illnesses/promoting mental health. Each priority starts with vision and mission
statements and a discussion of data from the 2013 Dakota County Community Assessment that
supports the importance of this priority. The section for each priority includes several goals
with objectives and strategies. Below are definitions of key terms used in these sections (14):
Vision sets forth the “ideal” state that the community wants to achieve. It provides long-term
direction and guidance for the community.
Mission indicates how the community intends to achieve the vision.
Values are beliefs or principles that the community members hold in common and strive to put
into action.
Goal is a fundamental issue the community needs to address. It is a desired end, which is not
necessarily attainable or quantifiable.
Objective is a measurable outcome that the community wants to achieve by focusing on the
particular goal.
Strategy is a broadly stated means of utilizing resources to achieve the goals. The strategies are
understood to contribute to meeting the objective.
Action plan is a document which includes tactics that describe who, what, when, where and
how activities will take place to implement a strategy.
Citations within the plan are designated by a number in parentheses, which corresponds to a
numbered reference at the end of the document.
Dakota County Community Health Improvement Plan, 2014-2019
10
Priority 1: Physical Activity/Eating Habits/Obesity
Vision
Improved health for residents, reduced incidence and prevalence of chronic disease, reduced
health disparities, and reduced health care costs.
Mission
Create sustainable policy, system, and environmental changes to increase access to healthy
food, increase opportunities to be physically active and increase breastfeeding support.
The strategies for this portion of the plan are being implemented under the Statewide Health
Improvement Program (SHIP) grant. SHIP is a program developed by the Minnesota
Department of Health that employs evidence-based strategies for community-led
improvements in healthy eating and physical activity (15).
Why improving physical activity and eating habits is important
Obesity is epidemic in the United States. Since the late 1970s, the prevalence of overweight and
obesity in the United States has nearly doubled in adults, more than doubled in children and
more than tripled in adolescents. Maintaining a healthy weight is an important part of overall
health. Being overweight or obese increases the risk for many chronic conditions that can lead
to disability and death, including high blood pressure, type 2 diabetes, heart disease, stroke,
osteoarthritis and certain cancers. Lack of physical activity and unhealthy eating habits are the
primary risk factors for becoming overweight or obese. Obesity affects all genders, ages, and
racial and ethnic groups. In 2008, the Minnesota Department of Health estimated that medical
expenses due to obesity were approximately $2.8 billion (16; 17; 18).
In 2010, 60 percent of Dakota County adults reported height and weight that classified them as
overweight or obese (34 percent overweight but not obese, 26 percent obese). This was below
the statewide percent (63 percent), but exceeded the 2020 Minnesota target of 53 percent
overweight or obese. The highest percent of overweight or obese was in persons aged 45-54.
People with incomes at or below 200 percent of poverty also had a higher rate of being obese
than the general population. In 2012, 11 percent of children ages 2-5 years enrolled in WIC
were obese, compared to 13 percent statewide. The Healthy People 2020 goal is 9.6 percent for
children in this age group. Statewide, American Indian children enrolled in WIC had the highest
Dakota County Community Health Improvement Plan, 2014-2019
11
rate of obesity. Nineteen percent of Dakota County 8th graders, 20 percent of 9th graders and
20.5 percent of 11th graders were overweight or obese in 2013. This was above the Healthy
People 2020 goal of 16 percent for adolescents (19; 17; 20; 13; 21).
Unhealthy eating and physical inactivity contribute to the development of obesity and chronic
diseases, such as heart disease, stroke, type 2 diabetes, high blood pressure, osteoporosis and
certain cancers. Unhealthy diets include too many calories, too much saturated fat and added
sugar and sodium, and too few nutrients from not eating enough fruits and vegetables.
Physical inactivity is one of the most important risk factors for chronic disease in the United
States. Regular physical activity helps reduce the risk of heart disease, stroke, diabetes, and
certain cancers; helps control weight; strengthens bones, muscles, and joints; prevents falls or
helps reduce injuries from falls among older adults; and relieves anxiety and depression. People
who live in communities that support active living are more likely to engage in physical activity
as part of their daily routine, such as walking or biking for transportation.
The percent of Dakota County students who were moderately physically active for 30 or more
minutes on five of the last seven days slightly increased from 1998 to 2010 for all grades. In
2013, the percent of students getting at least 60 minutes of physical activity each day were: 19
percent (5th graders), 20.5 percent (8th graders), 21 percent (9th graders) and 18 percent (11th
graders). Dakota County students in all grades, except 5th grade, did slightly better than the
state in 2013 (5th graders: 21 percent, 8th and 9th graders: 20 percent, and 11th graders: 17
percent). Hispanic and Asian students are less likely to meet the recommendation than White
students. In 2010, 78 percent of Dakota County adults met the national recommendations of
150 minutes or more of moderate or vigorous activity per week, which is above the 2020
Minnesota target of 75 percent. Females, older people, those with less than a college
education and those with incomes at 200 percent of poverty or less were less likely to meet the
recommendation. Nationally, Blacks/African-Americans and Hispanics are less likely to meet the
recommendation (19; 16; 17; 21).
The percent of Dakota County students who ate five or more servings of fruits and vegetables
the previous day stayed relatively stable for 6th graders and slightly increased for 9th and 12th
graders from 1998 to 2010. Sixth-graders had the highest percent; 12th graders the lowest. 2010
percents: 21 percent (6th graders), 20 percent (9th graders), and 18 percent (12th graders).
Dakota County 6th and 12th graders did about the same as the state. Ninth graders did slightly
better than the state percent (18 percent). The Healthy Minnesota 2020 target is 30 percent for
all students. In 2010, 41 percent of adults reported eating five or more servings of fruits and
vegetables the previous day. Males, people with less than a college education and people with
incomes at 200 percent of poverty or less were less likely to have eaten five or more servings of
Dakota County Community Health Improvement Plan, 2014-2019
12
fruits and vegetables. The Dakota County percent was better than the state percent in 2009 (22
percent) (22; 17; 19).
Breast milk has immune-boosting and anti-inflammatory properties that decrease the risk of
many childhood diseases. There is also evidence that breastfeeding decreases the risk of
obesity and other chronic diseases, such as type 2 diabetes and asthma. In Minnesota, 73.5
percent of infants are ever breastfed, compared to 76.5 percent nationally. Forty-nine percent
are breastfed at six months in Minnesota and nationally. Twenty-three percent are breastfed at
12 months, compared to 27 percent nationally. Minnesota is below the Healthy People 2020
goals: 81.9 percent ever breastfed, 60.6 breastfed at six months, and 31.1 at one year (23; 17;
13).
Dakota County Community Health Improvement Plan, 2014-2019
13
Theory of change
Short-term
Medium-term
Long-term
More healthy foods
and fewer unhealthy
foods available at
work, child care, school
and in the community
People have healthier
eating habits
throughout their
lifespan
Fewer people are
overweight and obese
throughout the
lifespan
Child care/preschools,
worksites, and health
care providers provide
support to help
mothers continue to
breastfeed
Mothers breastfeed for
a longer duration
Fewer people are
overweight and obese
throughout the
lifespan
More physical activity
opportunities available
at work, child care,
school and in the
community
People are more
physically active
throughout their
lifespan
Health care providers
will screen, counsel,
and refer people with
high body mass index
(BMI)
People with overweight
and obesity are
provided with
opportunities to better
manage their weight
Fewer people are
overweight and obese
throughout the
lifespan
Cities make
infrastructure changes
to increase walkability
and bikeability in the
community
Residents engage in
active transportation
methods throughout
their lifespan
Fewer people are
overweight and obese
throughout the
lifespan
Fewer people are
overweight and obese
throughout the
lifespan
Dakota County Community Health Improvement Plan, 2014-2019
14
Goal 1: Dakota County children and adolescents will have increased access to
nutritious foods*, increased opportunities for physical activity and access to
screening, counseling, and referral if at risk of developing chronic disease.
OBJECTIVE
1.1 By September 30, 2019, reduce the percent of
preschool children who are obese to 10% (1%
from baseline) (13)
Strategy
Baseline
11%:
2-5 year olds
(2012) (24)
Timeframe
Data source
WIC Pediatric
Nutrition
Surveillance System
Partners
1.1.1 Child care/preschool programs will implement policy,
systems, and/or environmental changes to increase
access to healthy foods. (Focus: those serving lowincome and racially/ethnically diverse populations)
2014-2019
Dakota County Public
Health, child care
providers/ preschool
programs
1.1.2 Child care/preschool programs will implement policy,
systems, and/or environmental changes to decrease
access to unhealthy foods. (Focus: those serving lowincome and racially/ethnically diverse populations)
1.1.3 Child care/preschool programs and worksites will
implement policy, systems, and/or environmental
changes to support breastfeeding mothers. (Focus:
those serving low-income and racially/ethnically diverse
populations)
1.1.4 Child care/preschool programs implement policy,
systems, and/or environmental changes to increase
access to physical activity. (Focus: those serving lowincome and racially/ethnically diverse populations)
1.1.5 Strategy removed
1.1.6 Health care providers will screen, counsel and refer
children and adolescents with high BMI. (Focus: those
that serve a high proportion of patients who are
uninsured or on Medical Assistance; racially/ethnically
diverse patients; or infants/pregnant women)
2014-2019
Dakota County Public
Health, child care
providers/ preschool
programs
Dakota County Public
Health, child care
providers/preschool
programs, worksites
Dakota County Community Health Improvement Plan, 2014-2019
2014-2019
2014-2019
Dakota County Public
Health, child care
providers/preschool
programs
2014-2015
Dakota County Public
Health, health care
providers
15
OBJECTIVE
1.2 By September 30, 2019, reduce the percent of
children and adolescents who are obese to 7%
(1% from baseline).
Strategy
Baseline
8% of 9th
graders
(2013) (21)
Timeframe
Data source
Minnesota Student
Survey
1.2.1 School districts will implement policy, systems, and/or
environmental changes to increase access and
availability of fruits and vegetables.
1.2.2 School districts will implement policy, systems, and/or
environmental changes to decrease access to foods
high in sodium, saturated fat, and/or added sugar.
1.2.3 School districts will implement policy, systems, and/or
environmental changes to increase access to physical
activity before, during, and after school.
2014-2019
Dakota County Public
Health, school
districts
Dakota County Public
Health, school
districts
Dakota County Public
Health, school
districts
Dakota County Community Health Improvement Plan, 2014-2019
2014-2019
2014-2019
Partners
16
Goal 2: Dakota County adults will have increased access to nutritious foods*,
increased opportunities for physical activity and access to screening, counseling,
and referral if at risk of developing chronic disease.
OBJECTIVE
2.1 By September 30, 2019, increase the percent of
adults who are at a healthy weight to 47% (7% from
baseline) (17).
Strategy
2.1.1 Worksites will implement policy, systems, and/or
environmental changes to increase access to healthy
foods and decrease access to unhealthy foods in vending
machines, catering, and on-site food services. (Focus:
organizations that fit one or more of the following
criteria: employ a diverse workforce, with more than 10%
employees of color, have less than 200 employees, or
have greater than 50% employees age 45 years or older)
2.1.2 Worksites will implement policy, systems, and/or
environmental changes to increase opportunities for
physical activity. (Focus: organizations that fit one or
more of the following criteria: that employ a diverse
workforce with more than 10% employees of color, have
less than 200 employees, or have greater than 50%
employees age 45 years or older)
2.1.3 Create a local food coalition to increase access to healthy
foods and decrease access to unhealthy foods. (Focus:
low-income, food insecure families)
2.1.4 Increase the number of farmers’ markets that accept
EBT/SNAP/WIC.
2.1.5 Hospitals will direct community benefit programs to
healthy eating, physical activity and chronic disease
prevention.
2.1.6 Strategy removed
2.1.7 The county and cities will develop plans and systems and
secure funding to improve walkability or bikeability in the
community to increase active transportation among lowincome residents and residents age 60 years or older.
Dakota County Community Health Improvement Plan, 2014-2019
Baseline
36% (adults
25 and older)
(2010) (25)
Timeframe
Data source
Metro SHAPE
Survey
2014-2017
Dakota County
Public Health,
worksites
2014-2017
Dakota County
Public Health,
worksites
2014-2019
Farmers’ markets,
food shelves
2014-2015
Farmers’ markets
2014-2015
Hospitals, Center
for Community
Health
2014-2019
Dakota County
Physical
Development,
cities, Active Living
Dakota County
coalition
Partners
17
2.1.8 Community agencies will increase offerings of evidence2014-2015
based prevention services. (Focus: those in geographic
areas that are low-income or diverse or who offer services
to people age 60 years or older)
Dakota County
Public Health,
community
agencies
Target outcomes are based on state or national goals (Healthy Minnesota 2020 (17) or Healthy
People 2020 (13)), when available. If a state or national goal was not available for a particular
measure, a goal was created by computing a 10 percent improvement over the baseline.
*Increased access to nutritious foods includes: increased access to fruits and vegetables and
reduced access to sodium, added sugar, and saturated fat.
Dakota County Community Health Improvement Plan, 2014-2019
18
Priority 2: Mental Illnesses/Promoting Mental Health
Vision
Children, adolescents, adults and families in Dakota County have opportunities to attain
optimal mental well-being.
Mission
Identify needs, provide education, reduce stigma, and promote access to mental health
services.
Values




Partnerships exist between consumers, community and providers that promote mental
well-being across the life span.
Residents with mental illnesses have opportunity to achieve their full potential and to
live in a community that is free of stigma and prejudice.
Residents with mental illnesses actively participate in designing, protecting and
strengthening their own mental health and well-being.
Residents have the skills, supports and resources to manage and recover from life
challenges that impact mental well-being.
Why improving mental health is important
Depression is a common but serious illness that requires treatment. Many individuals with
clinical depression may require antidepressant medications. Depression interferes with a
person’s ability to work, sleep, and engage in daily activities. Depression can range from mild to
severe, and severe cases may lead to self-injury and/or thoughts of suicide and suicidal actions.
(Not all adolescents who engage in self-injury have severe depression). Emotional distress in
adolescents can impair development and learning and interfere with sound decision-making. It
can also lead to self-harm in adolescents, including cutting, suicide attempts, and suicide. An
estimated six percent of Minnesota adults experienced significant depressive symptoms during
the past year and four percent had symptoms suggestive of serious mental distress. Mental
illnesses are a leading cause of disability in the United States. Socioeconomic factors and other
social determinants of health, such as low income and poor educational attainment, are
associated with poor mental health (26; 27; 28; 29).
Dakota County Community Health Improvement Plan, 2014-2019
19
Another useful measure of mental health in the population is the average number of mentally
unhealthy days. This measure is based on the self-reported number of days that mental health
was not good in past 30 days. An average is computed for all persons who reported and it is
age-adjusted to allow for comparison across different geographic regions. This measure can
help characterize the burden of stress, depression, and emotional distress in a population. For
the years 2006-2012, Dakota County residents reported an average of 2.5 mentally unhealthy
days, below the state (2.6 days) and above the national (2.4 days) benchmarks (30).
An estimated six percent of Minnesota adults 18 and older reported having at least one episode
of major depression in 2012-13. The rates were highest among 18-25 year olds (nine percent).
Minnesota is slightly above the Healthy People 2020 goal of 5.8 percent. More than onequarter of Dakota County students said that they had significant problems during the past year
with feeling very trapped, lonely, sad, blue, depressed or hopeless about the future (2013: 24.5
percent of 8th graders, 28 percent of 9th graders, and 34 percent of 11th graders). Eighth and
9th graders were below the state, but 11th graders were above the state (32 percent) for 2013.
Students of color were more likely to have had significant problems during the past year than
White students. In the 2012-13 school year, four percent of students in Dakota County public
schools were estimated by the school nurse to have depression or anxiety. This is a slight
increase from two percent estimated in 2008-09 (21; 13; 31).
Ultimately, mental illnesses can result in a person harming or killing themselves. Suicide is a
serious public health problem with long-term consequences for individuals, families, and
communities. Family members and friends who survive losing someone to suicide are often
deeply impacted and are at increased risk for suicide themselves. Completed suicides are only
part of the picture - more people survive suicide attempts than die. Suicide attempts can result
in serious injuries that require costly medical care (32; 17).
Suicide is one of the leading causes of death in Dakota County. For 15-24 year olds, it was the
leading cause of death in 2012. For the period 2009-2011, the age-adjusted death rate for
suicide in Dakota County (12.0 per 100,000) was above the statewide rate (11.5 per 100,000).
The suicide rate increased by 35 percent from 2007 to 2010 (from 8.9 per 100,000 to 12.0 per
100,000), after several years of relative stability. It is above the Healthy People 2020 goal of
10.2 per 100,000. Males have a higher rate of suicide than females. During the period 20092011, the highest rate of suicide in Dakota County was in 45-54 year olds. Statewide, the
highest rate of suicide is in American Indians (33; 34; 13; 17).
Ninth graders are the most likely to have thought about killing themselves. In 2013, 14 percent
of Dakota County 8th graders, 15 percent of 9th graders and 14 percent of 11th graders had
significant problems during the past year with thinking about ending their life or completing
Dakota County Community Health Improvement Plan, 2014-2019
20
suicide. Eighth and 9th graders were similar to the state, but 11th graders were slightly above
the state (13 percent) for 2013. In 2013, 3.5 percent of 8th graders, four percent of ninthgraders and three percent of 11th graders said they had attempted suicide during the past year.
This is similar to the state. Students of color, with the exception of Asian students, are more
likely to have had suicidal thoughts or attempted suicide than White students (21).
Dakota County Community Health Improvement Plan, 2014-2019
21
Theory of change
Short-term
Medium-term
Long-term
Dakota County Healthy
Communities
Collaborative holds an
annual mental health
summit
Community partners,
including school-linked
partners, refer youth to
the appropriate
community resources
Fewer suicide attempts
in youth
People who have
mental health concerns
seek treatment and
adhere to treatment
Adults with mental
illness experience a
reduction in
symptomatic days
Primary care providers
and schools screen and
treat people for mental
illnesses
More people who have
mental illnesses access
resources and get
needed treatment
Fewer youth and adults
delay getting needed
mental health care
People understand
how to navigate the
mental health system
and what to expect
More people who have
mental illnesses access
resources and get
needed treatment
Fewer youth and adults
delay getting needed
mental health care
Mental health services
are available that meet
the needs of the
community
More people who have
mental illnesses access
resources and get
needed treatment
Fewer youth and adults
delay getting needed
mental health care
Providers, faith
communities, and
community agencies
are trained in youth
mental health first aid
Community members
recognize mental
illnesses and are able
to assist youth in
getting professional
help
Communities have the
capacity to promote
and protect mental
health
Stigma associated with
mental illnesses is
reduced through public
awareness
Dakota County Community Health Improvement Plan, 2014-2019
22
Goal 1: Community partners in Dakota County will adopt mental health
promotion strategies that emphasize protective factors and self-sufficiency.
1.1
OBJECTIVE
By September 30, 2019, reduce the percent of
youth who attempted suicide in the past year to
3% (1% from baseline).
Strategy
1.1.1 Continue to convene Dakota County Healthy
Communities Collaborative (DCHCC) network, whose
work includes organizing an annual Mental Health
Summit.
1.1.2 Assist schools with implementing best practices for
mental health promotion.
1.2
OBJECTIVE
By September 30, 2019, reduce the average
number of mentally unhealthy days for adults in
the past 30 days to 2.3 days (10% improvement
over baseline) (30).
Strategy
1.2.1 Increase public awareness of positive mental health
practices through social marketing campaigns and
training, such as “Make It OK”, Ending the Silence, and
Mental Health Awareness Month (May). (Primary target:
low-income populations)
Baseline
4% of 9th
graders
(2013) (21)
Timeframe
Data source
Minnesota
Student Survey
2014-2019
Dakota County
Healthy
Communities
Collaborative
Dakota County
Public Health
2016-2019
Partners
Baseline
2.6 days
(2014) (30)
Data source
County Health
Rankings
Timeframe
Partners
2014-2019
Dakota County
Public Health, NAMI
MN, Dakota County
Social Services,
Dakota County
Community
corrections, Dakota
County Attorney’s
Office, Fairview
Ridges Hospital,
Center for
Community Health,
other trained
partners
1.2.2 Strategy removed.
Dakota County Community Health Improvement Plan, 2014-2019
23
Goal 2: Community partners in Dakota County will assure access to appropriate
services and programs that support optimal mental well-being.
OBJECTIVE
2.1 By September 30, 2019, reduce the percentage of
adults who delay getting mental health care to
54% (2% from baseline).
Strategy
2.1.1 Strategy removed
2.1.2 Increase the understanding of the public and referral
sources on how to navigate the mental health system,
using a variety of media and methods.
2.1.3 Increase public awareness of positive mental health
practices through social marketing campaigns and
training, such as “Make It OK”, NAMI’s Ending the
Silence, and Mental Health Awareness Month (May).
(Primary target: low-income populations)
2.1.4 Strategy removed
2.1.5 Ensure an adequate supply of mental health
professionals to meet community needs by identifying
data and strategies that demonstrate the need for
additional psychiatrists in the county, and by promoting
mental health careers in diverse populations.
2.1.6 Provide postvention consultations as needed after an
event in a community
OBJECTIVE
2.2 By September 30, 2019, among youth who
seriously considered or attempted suicide in the
past 12 months, increase the percentage who
received treatment during the past year to 32%
(2.8% from baseline).
Strategy
2.2.1 Engage school districts in identifying and referring
students with mental health needs, including
coordination of school-based and school-linked
services.
Dakota County Community Health Improvement Plan, 2014-2019
Baseline
56%
(2014) (25)
Data source
Metro SHAPE Survey
Timeframe
Partners
2014-2019
Dakota County Social
Services and collaboratives
2014-2019
Dakota County Public
Health, NAMI MN, Dakota
County Social Services,
Dakota County Community
corrections, Dakota
County Attorney’s Office,
Fairview Ridges Hospital,
Center for Community
Health, other trained
partners
2016-2019
NAMI MN
2016-2019
Dakota County Public
Health
Baseline
Data source
th
29% (8 ,
9th, and 11th
graders)
(21)
Minnesota Student Survey
(composite measure
developed by Dakota
County Public Health)
Timeframe
Partners
2014-2019
Dakota County Social
Services and collaboratives
24
Goal 3: Community partners in Dakota County will build local capacity and
leadership that creates optimal mental well-being.
3.1
OBJECTIVE
Baseline
By September 30, 2019, increase the readiness
4.1
score of the community to engage in mental health (2015)
promotion to 5 (one level from baseline).
Strategy
Timeframe
3.1.1 Identify a community readiness tool and develop a
baseline measurement.
3.1.2 Integrate mental health first aid in various settings
within the county.
2015
3.1.3 Increase public awareness of positive mental health
practices through social marketing campaigns and
training, such as “Make It OK”, NAMI’s Ending the
Silence, and Mental Health Awareness Month (May).
(Primary target: low-income populations)
2014-2019
3.1.4 Continue to convene Dakota County Healthy
Communities Collaborative (DCHCC) network, whose
work includes organizing an annual Mental Health
Summit.
3.1.5 Ensure an adequate supply of mental health
professionals to meet community needs by identifying
data and strategies that demonstrate the need for
additional psychiatrists in the county, and by promoting
mental health careers in diverse populations.
2014-2019
2014-2019
2016-2019
Data source
Dakota County
Mental Health
Readiness
Assessment (35)
Partners
Dakota County Public
Health
Dakota County Public
Health, Fairview
Ridges Hospital, NAMI
Dakota County Public
Health, NAMI-MN,
Dakota County Social
Services, Dakota
County Attorney’s
Office, Fairview
Ridges Hospital, Park
Nicollet
Dakota County
Healthy Communities
Collaborative
NAMI MN
Target outcomes are based on state or national goals (Healthy Minnesota 2020 (17) or Healthy
People 2020 (13)), whenever available. If a state or national goal was not available for a
particular measure, a goal was created by computing a 10 percent improvement over the
baseline.
Dakota County Community Health Improvement Plan, 2014-2019
25
Definitions
Below are definitions for key terms used in this plan. (See also p. 6)
Active transportation integrates physical activity into daily routines such as walking or biking to
destinations such as work, grocery stores or parks (36).
Bikeability indicates the extent to which people can get to where they want to go by bicycle. It
includes such things as safety, distance to destinations, and surface conditions (37).
Certified health care home: A health care home, or medical home, is an approach to health
care in which primary care providers, families and patients work in partnership to improve
health outcomes and quality of life, with an emphasis on care coordination. Minnesota has
developed a process to certify health care homes based on measureable criteria, including
patient tracking and registry and performance management and quality improvement.
Certified health care homes are eligible to receive care coordination payments (38).
Community health assessment is a systematic examination of the health status indicators for a
given population that is used to identify key problems and assets in a community. The ultimate
goal of a community health assessment is to develop strategies to address the community’s
health needs and identified issues (39).
Community health improvement plan is a long-term, systematic effort to address public health
problems on the basis of the results of community health assessment activities and the
community health improvement process. This plan is used by health and other governmental
education and human service agencies, in collaboration with community partners, to set
priorities and coordinate and target resources (39).
Community health improvement process involves an ongoing collaborative, community-wide
effort to identify, analyze, and address health problems; assess applicable data; develop
measurable health objectives and indicators; inventory community assets and resources;
identify community perceptions; develop and implement coordinated strategies; identify
accountable entities; and cultivate community ownership of the process (39).
Community readiness is the degree to which a community is ready to take action on an issue
(40).
Dakota County Community Health Improvement Plan, 2014-2019
26
Ending the Silence is a 50-minute classroom presentation for middle school and high school
students that raises awareness and changes perceptions around mental health conditions (41).
Evidence-based prevention services are clinical recommendations for screening, counseling
and other services that have been identified through scientific evidence reviews to be effective
interventions to prevent chronic disease (42).
Health equity occurs when every person has the opportunity to realize his/her health potential
— the highest level of health possible for that person — without limits imposed by structures or
systems of society, such as finance, housing, transportation, education, social opportunities,
etc., that unfairly benefit one population over another (43).
Healthy Minnesota 2020 is a framework for creating and improving health throughout the
state of Minnesota, based on the statewide health assessment, that includes measureable
targets for improvement (17).
Healthy People 2020 provides science-based, 10-year national objectives for improving the
health of all Americans (13).
Local food coalitions aim to identify and propose solutions to improve local food systems;
encourage local economic development; and increase consumer access to and the availability
of affordable, healthy foods such as fruits and vegetables (44).
“Make It Ok” is a social marketing campaign designed to reduce the stigma of mental illnesses
by encouraging open conversations and providing education on the topic (45).
Policy, systems and environmental change is an intervention that: creates or amends laws,
ordinances, resolutions, mandates, regulations or rules; impacts all aspects of an organization,
institution or system; or involves physical or material changes to the economic, social, or
physical environment. It is designed to create and encourage healthy behaviors in communities
(46).
Walkability: indicates the extent to which people can get to where they want to go by walking.
It includes such things as safety, distance to destinations, availability and condition of
sidewalks, and aesthetics (37).
Youth mental health first aid is designed to teach parents, family members, caregivers,
teachers, school staff, peers, neighbors, health and human services workers, and other caring
Dakota County Community Health Improvement Plan, 2014-2019
27
citizens how to help an adolescent (age 12-18) who is experiencing a mental health or
addictions challenge or is in crisis (47).
Dakota County Community Health Improvement Plan, 2014-2019
28
Dakota County Healthy Dakota Initiative
Collaborating Organizations
360 Communities
Metcalf Junior High
Active Living Dakota County
Dakota County Social Services
Department
Akin Road Elementary
Dakota Electric Association
Allina Health Regina Hospital
Dakota Ridge School
Moreland Arts & Health
Sciences Magnet School
Apple Valley High School
Dick’s Sanitation Inc.
Apple Valley Medical Center
Eastview High School
National Alliance on Mental
Illness (NAMI) Minnesota
Bird & Cronin Inc.
Echo Park Elementary School
Nicollet Junior High
Black Hawk Middle School
Factory Motor Parts Company
Northfield Hospital & Clinics
Blue Cross and Blue Shield of
Minnesota (The Center for
Prevention)
Fairview Ridges Hospital
Northview Elementary
Family Adolescent and Children
Therapy Services (FACTS)
Park Nicollet Clinic - Burnsville
Carciofini Company
Farmington Elementary School
Parkview Elementary
CaringBridge
Farmington High School
Patterson Companies, Inc.
Cedar Park Elementary STEM
School
Friendly Hills Middle School
Pilot Knot STEM Magnet School
Garlough Environmental
Magnet School
Pinecrest Elementary School
Christina McAuliffe Elementary
School
Gideon Pond Elementary School
Rahn Elementary School
Guild Incorporated
City of Apple Valley
Randolph Elementary School
Harriet Bishop Elementary
School
Randolph Secondary School
Center for Community Health
City of Burnsville Fire
Department
City of Eagan Parks &
Recreation
Hastings High School
Hastings Middle School
Henry Sibley High School
Mi Familia Child Care Center
Park Nicollet Foundation
Pinewood Community School
Red Pine Elementary
Restaurant Technologies, Inc.
Riverview Elementary School
Heritage E-STEM Magnet School
Robert Boeckman Middle
School
CommonBond Communities
Hidden Valley Elementary
School
Saint Mary's Health Clinics
Dakota Child and Family Clinic
Independent School District 192
Dakota County
Independent School District 196
Dakota County Attorney's Office
Independent School District 197
Dakota County Breastfeeding
Coalition
Independent School District 200
City of South Saint Paul
City of West Saint Paul
Dakota County Healthy
Communities Collaborative
Dakota County Human Services
Advisory Committee
Dakota County Physical
Development Division
Dakota County Public Health
Department
Scott Highlands Middle School
Somerset Elementary School
South Saint Paul Secondary
The Open Door
Innovative Office Solutions
University of Minnesota
Extension Services
Kaposia Education Center
Elementary
Valley Middle School
Kennedy Elementary School
Westview Elementary School
Levi P. Dodge Middle School
Willliam Byrne Elementary
School
Lincoln Center Elementary
103 family child care home
Living Well Disability Services
Marion W. Savage Elementary
School
Dakota County Community Health Improvement Plan, 2014-2019
29
Acknowledgments
Thank you to the following individuals for their contributions to the Community Health
Improvement Plan:
Healthy Dakota Initiative Steering Committee











Joan Bertelsen, Independent School District 196 – Rosemount, Apple Valley, Eagan
Brian Carlson, City of Burnsville Fire Department
Barb Doherty, Dakota County Human Services Advisory Committee
Linda Feist, Dakota County Human Services Advisory Committee
Tammy Hayes, Northfield Hospital & Clinics
Peggy Johnson, Dakota Electric Association
Mary Kaphings, Fairview Ridges Hospital
Connie Marsolek, Park Nicollet Clinic - Burnsville
Sal Mondelli, 360 Communities
Juli Seydell Johnson, City of Eagan Parks and Recreation Department
Karen Strauman, Allina Health Regina Hospital
Statewide Health Improvement Program Community Leadership Team














Olga Ahumada, 360 Communities
Gary Anger, Red Pine Elementary (ISD #196)
Bonnie Brueshoff, Dakota County Public Health
Kurt Chatfield, Dakota County Physical Development, Office of Planning
Lisa Damon, Allina Health Regina Hospital
Stacy Endres, Common Bond Communities
Marshall Grange, City of Eagan
Lisa Horn, The Open Door
Mary Montagne, Dakota County Public Health
Sharmyn Phipps, University of Minnesota Extension
Anika Rychner, 360 Communities
Deb Thingstad Boe, Dakota County Public Health
Michelle Trumpy, Dakota County Public Health
Janelle Waldock, Blue Cross Blue Shield of Minnesota, Center for Prevention
Dakota County Community Health Improvement Plan, 2014-2019
30

Mental Health Action Team










Shannon Bailey, Dakota County Public Health
Sue Carey Rosenbush, Fairview Ridges Hospital
Melanie Countryman, Dakota County Public Health
Howard Epstein, Dakota County Public Health
Monica Jensen, Dakota County Attorney’s Office
Libby Lincoln, Park Nicollet Foundation
Janell Schilman, Dakota County Social Services
Luke Spiegelhoff, Family Adolescent and Children Therapy Services (FACTS)
Stephen Tye, National Alliance on Mental Illness (NAMI) Minnesota
Shelley Wagner, Allina Health Regina Hospital
The following Dakota County Public Health Department staff members were instrumental in
producing the Community Health Improvement Plan: Shannon Bailey, Wendy Bauman, Bonnie
Brueshoff, Melanie Countryman, Howard Epstein, Laura Fitzsimmons, Lori Lorentz, Jess Luce,
Mary Montagne, Michelle Trumpy. We would also like to thank the Dakota County Healthy
Communities Collaborative for sponsoring the work on the mental health section of the plan.
Dakota County Community Health Improvement Plan, 2014-2019
31
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Dakota County Community Health Improvement Plan, 2014-2019
34
Appendix A
Community Strengths
The Healthy Dakota Initiative Steering Committee identified resources that may be available to
contribute to or support community health initiatives. Committee members considered the
following question: “What assets/strengths can be drawn upon in Dakota County to fulfill the
vision of the Healthy Dakota Initiative?” Below is the list that resulted:
Organizations
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Non-profits (e.g., DARTS, CAP Agency, 360
Communities, Neighbors, Hastings Family
Service)
Schools
Libraries
Faith organizations
Hospitals and health clinics
Food shelves
Senior centers
Cities, including police and fire
Social clubs (e.g., Elks, Moose, Rotary,
Kiwanis)
Youth-serving organizations (e.g., 4-H,
Scouts, athletic associations)
Apartment and housing complexes
Interest groups (e.g., biking clubs)
Art centers
Professional and business associations
Political parties
Local media, including local cable access,
local newspapers, radio stations, school
newsletters, and social media
Places
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Community events
Restaurants and bars
Sporting events
Schools
Businesses
Malls
Community centers
People
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Political leaders
Retired people
Boomers and “young seniors”
Mentors
Community initiatives
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City and county staff for outreach
Current city and county groups and
projects
Neighborhood associations
The Steering Committee noted that these community resources are an important source of
knowledge, skills, and connections that will be very useful in developing and implementing
community health improvement strategies.
Dakota County Community Health Improvement Plan, 2014-2019
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Appendix B
Forces of Change
The forces of change assessment completed by the Healthy Dakota Initiative Steering
Committee identified external factors that may influence health, such as policy changes, social
movements, economic and political trends, and technological developments. Committee
members considered trends and events that have occurred recently or may occur in the future.
Opportunities and threats were identified for each of the forces that were identified (7).
Table 1 – Forces of change with threats and opportunities
Category
Force
Threats
Opportunities
Economic factors
Insurance/Affordable
Care Act
Who will pay?
Economic incentives for
personal responsibility
Economic
slowdown/recovery
Poverty
Insurance costs, deductibles and copays
rising, but still not covering the cost of care
Decreasing reimbursement for health care
providers
People may not understand changes
People may not comply with mandate
Cost of not having insurance to individuals
More costly for employers to provide
coverage than to pay the penalty
Bankruptcies due to medical costs
Lack of personal accountability
Steady or increasing need for public
assistance
Decreasing tax levies
Impact on families, communities and
schools
Not enough public funding for waiver
programs – frail elderly have to go to
nursing homes before they need to
Unpredictability
Not enough transportation options
Lack of affordable housing
Technology is becoming necessary
People require more training to be
employable
Dakota County Community Health Improvement Plan, 2014-2019
Push for innovation
Older adults continuing to work
Create more transportation
options
Bring technology to a broader
population
New educational opportunities
that lead to employment (ex.
PSEO)
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Category
Communication/
Technology
Force
Threats
Opportunities
Rapid change in technology/difficult to
predict where it is going
Increased public
knowledge/culture shift toward
greater health awareness
Ease of partnering with other
organizations
Use of technology for remote
communications and diagnosis
Create reliable information
source (filter)
Unknown impact to the community
Increased amount of screen time
Not all information on the internet is
correct & reliable/potential for
misinformation
Increased reliance on non-personal
communication/increased isolation
Too much information
Difficulty during some disaster scenarios
Not equally accessible to all incomes &
social groups/part of population doesn’t
have access
Costly to purchase and implement
Having technology is becoming a necessity
Technology can crash
High learning curve/need for education to
use
Not everything is on the grid
Privacy and security breaches
Dakota County Community Health Improvement Plan, 2014-2019
Increased communication
Virtual support groups,
connection over long distances
New communication channels
to access
Can eliminate transportation
barriers (virtual)
Easier to monitor health “at
home” and
address/communicate
Cost is decreasing
Integration of intake (Every
Door is Open)
Longer lives
Improved ease of use
MNSure signup?
Improved privacy due to not
having everything on paper
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Category
Force
Threats
Health issues
Mental health
issues/suicide
Lack of providers=untreated
Chronic disease
Increased homelessness, crime, etc.
Uncertain long-term impact of wellness
campaigns/efforts
Decreased healthy behaviors in adolescents
Lack of personal accountability
Food supply – cost, quality, accessibility
Education to learn good decision-making
Two parents working
Cost of extracurricular sports
Environment
Disaster
preparedness
Social/demographic
changes
Aging of population
Increasing diversity
Suburban
environment/built
environment
Dual-income
households/singleparent households
Lack of transportation to sports
Loss of trees due to infestation and disease
Loss of healthy landscapes & green areas
for recreation & relaxation
Loss of “nature ethic” – being comfortable
in the great outdoors
Climate change/unprepared for natural
disasters
Terrorism
Changes in family composition/fewer
caretakers (“sandwich” effect)
Increased numbers of older adults
Increased demands on services, health care
Technology makes it more difficult to
access information
Social isolation/unable to leave residence
Transportation challenges
Need for home care
Communication/language barriers
Diverse needs
Illiteracy
Immigrants may need to learn computer
skills
Cul-de-sacs
Spread-out
Unsafe bridges/infrastructure
Reliance on personal autos
Unable to miss work-delay in receiving
health care
Dakota County Community Health Improvement Plan, 2014-2019
Opportunities
Greater emphasis on
prevention
Health care homes – greater
integration
Improvements in food supply
New discoveries, ex. personspecific treatments
Family support
Innovations, such as Nurselines,
disease management programs
Changes to systems and built
environment
Family support
More volunteerism
More information available
English as a second language
New ways to do things
More ways for people to
become involved
Increased understanding of
diverse populations
Fewer volunteers available
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Appendix C
Revision History
Changes
Document reviewed
Revisions made:
Date
3/24/2015
2/2/2016
Priority 1: Obesity
1.1.5 – changed timeframe to 2014-2015 – strategy ended in 2015
1.1.6 – changed timeframe to 2014-2015 – strategy ended in 2015
2.1 - changed baseline from 40% to 36% to account for recalculation to adults 25
and older
2.1.4 – changed timeframe to 2014-2015 – strategy ended in 2015
2.1.5 – changed timeframe to 2014-2015 – strategy ended in 2015
2.1.6 – changed timeframe to 2014-2015 – strategy ended in 2015
2.1.8 – changed timeframe to 2014-2015 – strategy ended in 2015
Priority 2: Mental Health
1.1.2 – new strategy
1.2.1 – added partners; changed timeframe to 2014-2018
2.1 – added baseline and target measurements
2.1.3 – added partners; changed timeframe to 2014-2018
2.1.6 – new strategy
2.2 – revised baseline and target measurements due to error in calculation
3.1 - Added baseline and target measurements and data source
3.1.6 – new strategy
Revisions made:
1/19/2017
Changed plan date from 2018 to 2019 to more accurately reflect the plan’s timeline
(10/1/2014-09/30/2019). Changed the date in all objectives to September 30, 2019 and
the end date of all strategies that ended in 2018 to 2019.
Revised “Implementation and Monitoring of Plan” on pp. 26 to describe monitoring
process in more detail and to include criteria for plan revision.
Priority 1: Obesity
1.1.5 – removed strategy – never adopted and not part of current grant cycle
2.1.6 – removed strategy – never adopted and not part of current grant cycle
Dakota County Community Health Improvement Plan, 2014-2019
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Changes
Date
Priority 2: Mental Health
1.2 - changed baseline and target measurements to reflect change in calculation of
data
1.2.1 – added NAMI’s Ending the Silence curriculum to the strategy
1.2.2 – removed strategy
2.1.1 – removed strategy
2.1.3 – added NAMI’s Ending the Silence curriculum to the strategy
2.1.4 – removed strategy
2.2 – changed objective from “youth who experienced high mental distress” to
“youth who seriously considered or attempted suicide” and changed baseline and
target measurements and data source description to change in measure.
3.1.2 – changed end date to 2019 – the strategy will continue beyond 2015
3.1.3 – added NAMI’s Ending the Silence curriculum to the strategy; changed end
date to 2019 – the strategy will continue beyond 2015
Dakota County Community Health Improvement Plan, 2014-2019
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