COLUMBIA COUNTY MAPP PROJECT
COLUMBIA COUNTY
DEPARTMENT of HEALTH
COMMUNITY HEALTH
IMPROVEMENT PLAN
Vision for Implementing MAPP
“Communities achieving improved health and quality of life
by mobilizing partnerships and taking strategic action.”
MAPP for Our Future
2012-2016
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COLUMBIA COUNTY MAPP PROJECT
Message from the Director of the Columbia County Department of Health
It is my pleasure to present to you The Community Health Improvement Plan for Columbia
County for 2012 – 2016. This document serves as a blueprint for health improvement in our
community. The development of this plan is the result of an assessment process that brought
together a representation of many Columbia County residents and professionals. This plan
should be used as a guide by community agencies interested in improving the public health and
safety of Columbia County residents. It is anticipated that this document will be used as a
reference and foundation for many efforts within the county.
Community change, and the resulting health improvements, is a difficult process that requires
dedication and commitment among all residents, as well as community and business sectors. I
invite all Columbia County residents to use this plan to improve individual, family and
community health.
I would like to express appreciation to all members of the Community Health Improvement
Plan Committee and Community Health Assessment Team whose efforts, insight and
knowledge are included in this document. I am extremely appreciative to the community
partners who have spent numerous hours over the past several years developing this plan.
Their involvement has been most valuable in helping to identify the health priorities for our
community.
Creating healthy communities requires a high level of mutual understanding and collaboration
with community individuals and partner groups. This health plan is being presented to
Columbia County members so that we can work together as partners to make our community a
healthier, safer place to live. It is with the help of you and others who will read and discuss this
plan and assist with the strategies that we will assure a healthy community. We invite you to
become involved with this project by contacting us at the Columbia County Health Department
at (518) 828-3358.
Sincerely,
Nancy A. Winch, R.N., M.S.
Public Health Director
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COLUMBIA COUNTY MAPP PROJECT
TABLE OF CONTENTS
Letter from the Director of the Department of Health ………………………………………………… pg. 2
Columbia County Vision Statement …………………………………………………………………………….. pg. 3
Our Working Definition of a Public Health System ………………………………………………………. pg. 3
MAPP Steering Committee Members …………………………………………………………………………. pg. 5
Executive Summary ……………………………………………………………………………………………………. pg. 7
The MAPP Model ……………………………………………………………………………………………………….. pg. 9
Columbia County at a Glance …………………………………………………………………………………….. pg.10
Phase I: Organizing for Success ………………………………………………………………………………….. pg. 11
Phase II: Creating a Vision for Columbia County...………………………………………………………. pg. 13
Phase III: The Four MAPP Assessments ……………………………………………………………………… pg. 15
Phase IV: Identifying Strategic Issues ………………………………………………………………………… pg. 25
Phase V: Formulate Goals and Strategies …………………………………………………………………. pg. 27
Phase VI: Action Cycle ……………………………………………………………………………………………… pg. 34
Appendix A: 10 Essential Public Health Services ………………………………………………………. pg. 36
Appendix B: The NYS Prevention Agenda toward the Healthiest State ……………………. pg. 40
Appendix C: Community Health Plan for the Five Specific Strategic Issues
Chronic Disease Prevention...……………………………………………………………. pg. 43
Mental Health and Substance Abuse ……………………………………………….. pg. 48
Community Partnerships …………………………………………………………………. pg. 52
Access to Quality Primary Care ……………………………………………………….. pg. 55
Workforce Development in the Healthcare System …………………………. pg. 58
Appendix D: The TOP FIVE of the Ranked and Combined Quadrant 2 Goals and Priorities
With Scores Over 35 ……………………………………………………………………….. pg. 60
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COLUMBIA COUNTY MAPP PROJECT
Columbia County Vision Statement
“A healthy community is clean, safe and has ready access to health care and all needed human
services. Community awareness, diversity and development are strengthened through
knowledgeable, engaged and nurturing involvement by many citizens and leaders who value
our population and usable resources, and support physical, mental, social, intellectual, and
spiritual well being. A healthy community has a strong Public Health System that includes:
planning and policy development, shared leadership among many community partners,
effective responses to challenges, assessment and accountability, and which protects and
promotes the health of residents of all ages and the natural and community environments.”
The Columbia County Community Health Planning Initiative
*******************************************************************
Our Working Definition of a Public Health System
“Public Health is the set of organized community efforts that fulfill society’s interest in assuring
conditions in which people can be healthy by applying scientific and technical knowledge to
prevent disease and promote health. The goal of public health is to improve the health status of
the population, with careful attention to and respect for the perspectives and values of the
diverse members of the community being served. There is a public health system in each
community defined as the wide range of public, private and voluntary organizations such as
governmental agencies, academia, health care providers, hospitals, community-based
organizations, associations, businesses, and individuals. The unique function of governmental
public health agencies within this broad infrastructure framework is to see that all vital system
elements are in place; that all core functions and essential services are coordinated; and that
the mission of improving the health of the community is adequately addressed, using if
necessary, the regulatory powers of the state.”
~taken from the NYS Health Dept. website~
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COLUMBIA COUNTY MAPP PROJECT
MAPP Steering Committee Members
The Columbia County Community Health Improvement Plan is the culmination of the many
efforts and generous support of various organizations and individuals who live and work in Columbia
County. Many hours, both personal and work, were devoted to this project. People shared their skills,
talents, and knowledge to the process of researching, discussing, analyzing and creating this master
health plan designed to improve the quality of life for Columbia County residents. It is our intent to
include the names of these incredible people so that the Columbia County community will have an
appreciation for the magnitude of the project and to give folks a sense of pride in their efforts. Thank
you, Thank you, and Thank you for all you have done!
Chris Acker
Debra Amerling
LT. Jim Andrews
Robin Andrews
Gina Armstrong
Tara Becker
Trudy Beicht
Bob Bodratti
Kim Botto
Roy Brown
Robert Burlingham
Marge Costello
Mary Daggett
Karen DePeyster
Michael DeRuzzio
James Dexter
Aubrey Feldman
Diane Franzman
Kristy Frederick
Linda Freligh
Joseph Fusco
William Gannon, Jr.
Michael Gelfand
Dan Geraghty
Edward Ginouves MD
Tom Gillespie
Jacqueline Goddeau
Annis Golden
Sheriff David Harrison
Judy Hettesheimer
Kary Jablonka
Sue Karicher
Rick Keaveney
Margaret Kennedy
Peter Konrad
Camphill Village
Columbia County Department of Social Services
Columbia County Sheriff’s Office
Columbia County Board of Supervisors
Healthcare Consortium
Columbia County Department of Health
City of Hudson Youth Director
Columbia-Greene Community College
Catholic Charities of Columbia and Greene Counties-WIC
Columbia County Board of Supervisors
Livingston Hills Nursing Home and Rehabilitation
Columbia County Department of Health
Columbia Memorial Hospital
Healthcare Consortium
Columbia County Department of Health
Ichabod Crane CSD
MPH Student Intern/SUNY Albany SPH
Healthcare Consortium
Columbia County Department of Health
NYS Department of Health
Columbia County Board of Health
for Assemblymember Peter Lopez
Mental Health Association of Columbia-Greene Counties
NYS Department of Health
Columbia County Board of Health
Catholic Charities of Columbia and Greene Counties
Columbia Memorial Hospital-Dental
SUNY Albany – Women’s Health Project
Columbia County Sheriff’s Office
Columbia County Department of Health
Columbia County Office of Aging
Columbia County Department of Social Services
Columbia County Board of Health
Columbia County Department of Human Services
Mental Health Association of Columbia-Greene Counties
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COLUMBIA COUNTY MAPP PROJECT
Bernadette Kowalski
John Laczynski
Susan Luck
Theresa Lux
John Mabb
Gary March
Allison Marron
Nancy Martin
Matthew Matsaganis
Theresa Mayhew
Amy McCabe
Sherri Mier
Jane Miller
Alice Mockvociak
Irene Morrissey
Paul Mossman
Peter Mullins
Carrie Multari
Clair Parde
David Pitaniello
Christine Pluviose
Arthur Proper
Tracy Proper
Betsy Rees
Kari Rieser
Mary Riley-Jacome
Jill Root
Katie Scheu
Beth Schuster
Nancy Shadic
Mark Shook
Rev. James Slater
Steve Speno
Kim Stack
Kenneth Stall
Craig Stanger
Marlene Stelling
Toni Strattman
Millie Sweatt
Mary Sweet
Rob Swider
Patrice Torrey
Sue Vanegghen
Bonnie-Jo Westendorf
Chris White
Nancy Winch
Dianne Wolff
Michelle Zeliph
NYS Department of Labor
Price Chopper Pharmacist
The Reach Center
Catholic Charities of Columbia and Greene Counties
Columbia County Department of Health
Fidelis
MPH Student Intern/SUNY Albany SPH
Columbia County Department of Health
Volunteer for Columbia County Health Department
Cornell Cooperative Extension of Columbia County
COARC
Columbia Memorial Hospital
Retired school librarian/volunteer
Germantown CSD
Valatie Senior Center
Columbia County Department of Social Services
Columbia County Board of Health
Columbia County Department of Human Services
Healthcare Consortium
Blue Shield of NE NY
UHPP
Pine Haven Nursing and Rehabilitation Center
Columbia County Sheriff’s Department
MPH Student Intern/SUNY Albany SPH
Healthcare Consortium
American Red Cross
Columbia County Department of Health
Columbia County Department of Health
Twin County Recovery Services
Columbia County Department of Health
Columbia Greene Community College Student Intern
St. Luke’s Lutheran Church
Columbia County Department of Health
Barnwell
COARC
Columbia Memorial Hospital
Columbia County Head Start
UHPP
Columbia County Department of Social Services
Columbia County Department of Health
NYS Department of Health
Fireman’s Home
Emergency Management Services
Cornell Cooperative Extension of Columbia County
Fidelis
Columbia County Department of Health
Columbia County Department of Health
RPI Student Intern
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COLUMBIA COUNTY MAPP PROJECT
EXECUTIVE SUMMARY
Every four years the local health departments in New York State are required to conduct a
community needs assessment and develop a health plan for the community. When preparing for the
2010-2013 assessment process, the Columbia County Department of Health made the decision to use
the Mobilizing for Action through Planning and Partnership (MAPP) process, which is a strategic
planning tool developed by the National Association of County and City Health Officials (NACCHO).
MAPP is a community-driven strategic planning tool for improving community health. The MAPP process
is facilitated by public health leaders and helps communities apply strategic thinking to prioritize public
health issues and identify resources to address them. MAPP is not an agency-focused assessment tool;
rather, it is an interactive process that can improve the efficiency, effectiveness, and ultimately the
performance of local public health systems. MAPP is a community driven process: community ownership
is fundamental; the community’s strengths, needs, desires and priorities drive the process; and
community participation leads to collective thinking and ultimately results in effective and sustainable
solutions to complex public health issues.
In the summer of 2009, the Columbia County Department of Health and Columbia Memorial Hospital
conducted a local needs assessment as required by the NYS Department of Health. At that time, they
also decided to do a more comprehensive assessment of the entire public health system in Columbia
County and to use the nationally recognized MAPP model developed by NACCHO. On June 10, a group of
44 partners assembled to begin the process of strategic planning for improving community health in
Columbia County. They were introduced to MAPP, established a time line and schedule for completing
the MAPP process and identified additional organizations and community groups to be involved in a
MAPP Steering Committee.
The next meeting was held in August at the Columbia-Greene Community College and was facilitated
by an Extension Educator. At this meeting, the MAPP Steering Committee utilized the community
visioning process to develop a Vision Statement and to identify Community Values, which can be found
on page 12 of this document. Both of these reflect what would make living in Columbia County feel like
a healthier place to live, work, and play.
In March of 2010, the formal MAPP Assessment Phase started, utilizing many individuals from the
community who represented various areas of expertise in the field of public health. The chart below
depicts the Four Areas of Assessment that were carried out.
Community Themes and
Strengths Assessment:
identifies themes that interest
and engage the community,
perceptions about quality of
life, and community assets
Local Public Health System
Assessment: measures the
capacity of the local public
health system to conduct
essential public health services
Forces of Change Assessment:
identifies forces that are
occurring or will occur that will
affect the community or the
local public health system
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Community Health Status
Assessment: analyzes data
about health status, quality of
life, and risk factors in the
community
COLUMBIA COUNTY MAPP PROJECT
EXECUTIVE SUMMARY (continued)
After the assessments were completed and the groups submitted their reports, it was time to
develop an ordered list of the most important issues facing the community. This was done by a small,
yet powerful group of people we referred to as our THINK TANK. They sifted through the issues that
were common to all four assessment areas and created a master list. THINK TANK members then
submitted their “top five” issues to the MAPP Steering Committee.
In late June of 2011, the MAPP Steering Committee met in a half day strategic issues planning session.
Their “charge” was to “Build a Campaign” for the issue they thought was the most important and to
make a case for why that issue should be one of the final four or five. The process was very successful
and with some creativity and consensus building, five major issues, with twelve related sub-issues were
identified and sent back to the THINK TANK for their consideration.
On August 10, 2011, the THINK TANK assembled, discussed the recommendations from the MAPP
Steering Committee, and agreed upon the following five strategic issues:
Chronic Disease Prevention and Management
Mental Health and Substance Abuses
Community Partnerships
Access to Quality Primary Care
Workforce Development
Phase V consisted of formulating goals and strategies for each of the strategic issues. Small work
groups consisting of existing MAPP members and others from the community, convened to brainstorm
potential goals and strategies that could be used to meet the needs of the five issues identified in Phase
IV. Potential barriers were also identified. It was important to ensure that the strategies identified fit
with the vision developed early in the MAPP process.
This phase was very time consuming as it required a great deal of research into best practices and
evidence-based methods of education used to accomplish specific goals and objectives. Crossreferencing between Healthy People 2020, the Center for Disease Control, the New York State
Prevention Agenda, NACCHO, the Guide to Community Preventive Services, and the New York State
Dept. of Health was the best method one could use in order to develop meaningful goals, objectives and
strategies. In total, 80 strategies were developed for the five strategic issues.
The sixth and final stage is the Action Cycle. This stage involves planning, implementation, and
evaluation. Each of these activities is intended to build upon the others in a continuous manner;
therefore this stage should never end. It became clear that someone would need to be in charge of
keeping track of the progress being made in the Action Cycle. We assembled a group of interested
people and asked for their ideas on how to start planning for our strategies. We met about six times and
ran through an arduous, yet thorough, ranking system to determine the top five strategies that the
group would recommend to the MAPP Steering Committee, the Board of Supervisors, and appropriate
committees. These can be found in Appendix D. These would begin the work of the Columbia County
Public Health System. This would involve devoting time, money and other resources to get the job done.
By completing this MAPP project, the Columbia County Health Department has positioned itself to move
forward with the national accreditation process through NACCHO and will make the department a tough
competitor for grant funds.
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COLUMBIA COUNTY MAPP PROJECT
The MAPP Model
To initiate the MAPP process, lead organizations in the community begin by organizing
themselves and preparing to implement MAPP (Organize for Success/Partnership
Development). Community-wide strategic planning requires a high level of commitment from
partners, stakeholders and the community residents who are recruited to participate.
The second phase of the MAPP process is to Create a Vision. A shared vision and common values
provide a framework for pursuing long-range community goals. During this phase, the community
answers questions such as “What would we like our community to look like in 10 years?”
Next, the four MAPP Assessments are conducted, providing critical insights into challenges and
opportunities throughout the community:
The Community Themes and Strengths Assessment provides a deep understanding of the
issues residents feel are important by answering the questions “What is important to our
community?” “How is quality of life perceived in our community?” and “What assets do we have
that can be used to improve community health?”
The Local Public Health System Assessment (LPHSA) is a comprehensive assessment of all of the
organizations and entities that contribute to the public’s health. The LPHSA answers the
questions “What are the activities, competencies, and capacities of our local public health
system?” and “How are the Essential Services being provided to our community?”
The Community Health Status Assessment identifies priority issues related to community health
and quality of life. Questions answered during this phase include “How healthy are our
residents?” and “What does the health status of our community look like?”
The Forces of Change Assessment focuses on the identification of forces such as legislation,
technology and other issues that affect the context in which the community and its public health
system operates. This answers the questions “What is occurring or might occur that affects the
health of our community or the local public health system?” and “What specific threats or
opportunities are generated by these occurrences?”
Once a list of challenges and opportunities has been generated from each of the four assessments,
the next step is to Identify Strategic Issues. During this phase, participants identify linkages between the
MAPP assessments to determine the most critical issues that must be addressed for the community to
achieve its vision.
After issues have been identified, participants Formulate Goals and Strategies for addressing each
issue.
The final phase of MAPP is the Action Cycle. During this phase, participants plan, implement, and
evaluate. These activities build upon one another in a continuous and interactive manner and ensure
continued success.
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COLUMBIA COUNTY MAPP PROJECT
Columbia County at a Glance
Columbia County is located in the northeastern region of the Mid-Hudson Valley of New York
State. It is bordered on the north by Rensselaer County, on the south by Dutchess County, on the east
by Berkshire County of the Commonwealth of Massachusetts and on the west by the Hudson River,
opposite Greene County. Columbia County is roughly rectangular, measuring approximately 20 miles
from east to west and 36 miles from north to south. It has a total area of approximately 643 square
miles or 411,520 acres. Based on the 2010 U.S. Census, Columbia County’s population is 63, 096. This
puts the county population density at 98 persons per square mile.
Columbia County is basically rural in nature and includes the City of Hudson and the following 18
towns: Ancram, Austerlitz, Canaan, Chatham, Claverack, Clermont, Copake, Gallatin, Germantown,
Ghent, Greenport, Hillsdale, Kinderhook, Livingston, New Lebanon, Stockport, Stuyvesant, and
Taghkanic, and the 4 villages of Chatham, Valatie, Kinderhook and Philmont.
In rural Columbia County, the local economy is one of diversified, small businesses, State of New
York and other agency and public employees, and commuters to businesses in the greater Albany area.
Columbia County is also home to a significant community of New Yorkers for whom the county is home
on weekends and during the summer months.
According to the 2010 U.S. Census, 15,900 are under the age of 18, 36,154 are between the ages
of 18 and 65, and 11,042 are over the age of 65. Columbia County ranks 8th in New York State for
persons aged 65 years and older and first for persons aged over 85 years.
Columbia County’s population is predominately white with 90.6% white compared to NYS at
65.7%. The Black population is 4.5% compared to NYS at 15.9%.
As a whole, Columbia County’s residents are at the state average for the percentage of
population high school with high school degrees. However, they are 4.2% below the state percentage
for attainment of a bachelor’s degree or higher.
The home ownership rate of 73% in Columbia County is considerably higher than that of the
state which is 55.7%. The median value of $212,200 of owner-occupied housing units, however, is
almost a third less than the state value of $300,600.
There are 25,358 households in Columbia County with a median household income of $49,795
compared to the state median household income of $54,554. Persons below the poverty level in
Columbia County are at 10.3% while the state level is 14.2%.
“Find out where the best country roads in America take you.”
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COLUMBIA COUNTY MAPP PROJECT
Phase I – Organizing for Success
Description and Purpose
The first phase of MAPP involves two critical and interrelated activities: organizing the planning
process and developing the planning partnership. The purpose of this phase is to structure a planning
process that builds commitment, engages participants as active partners, uses participants’ time well,
and results in a plan that can be realistically implemented. Also during this phase, it is necessary to
identify who will be involved in the partnership and to plan the process.
Community Involvement
Preparation for involving the community in the MAPP process predominates in this phase. During the
initial planning stages, the Core Support Team is responsible for most of the work as it prepares for the
MAPP process and recruits participants. This team consisted of staff from the Columbia County Health
Department and Columbia Memorial Hospital. As these two entities looked at how they were going to
meet the goals of the prevention agenda, they decided to adopt the MAPP model for community
involvement in goal implementation.
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COLUMBIA COUNTY MAPP PROJECT
This Core Team identified some additional key people from the community to assist them in planning
for the first community meeting. Finally, a larger group of community partners, 44, was identified and
invited to the first Community Health Planning Meeting on June 10, 2009. This group consisted of
representatives from a cross section of approximately 20 organizations, schools and community
agencies.
Process
In 2009, the Columbia County Health Department and Columbia Memorial Hospital conducted a local
needs assessment as required by the NYS Health Department every four years. At that time they also
decided to do a more comprehensive assessment of the public health system in Columbia County and to
use the nationally recognized MAPP model developed by NACCHO. Appropriate materials were ordered
from NACCHO and/or printed from the website.
Letters of invitation were sent in June 2009 to individuals identified as potential MAPP Committee
members. People were “invited to attend an organizational meeting to learn about a community-wide
strategic planning initiative for improving community health in Columbia County.” The goals for the
initial meeting were : to bring partners together; provide an introduction to MAPP; discuss mutual
concerns; identify needs; establish sub-committees; establish a time line and schedule; and prescribe
steps to complete the MAPP process. The group also identified additional organizations and community
groups that could/should be represented and/or invited to the next MAPP Steering Committee on
August 10, 2009.
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COLUMBIA COUNTY MAPP PROJECT
Phase II -- Creating a Vision for Columbia County
Description and Purpose
Visioning is the second phase of the MAPP framework. It guides the community through a
collaborative, creative process that leads to a shared community vision and common values.
Vision and values statements provide focus, purpose, and direction to the MAPP process so that
participants collectively achieve a shared vision of the future. A shared community vision provides an
overarching goal for the community – a statement of what the ideal future looks like. Values are the
fundamental principles and beliefs that guide a community-driven planning process.
Because visioning is done at the beginning of the MAPP process, it offers a useful mechanism for
convening the community and building enthusiasm for the process, setting the stage for planning, and
providing a common framework throughout subsequent phases.
Community Involvement
The visioning process could be carried out in a few ways. In Columbia County, it was decided to
conduct a community visioning process, which is a broad based process with 40 or more participants.
Community visioning is useful for engaging and mobilizing the broader community, but can be more
challenging to manage. The procurement of an excellent facilitator is key to making this particular
approach successful.
Process
Upon deciding to use the community visioning process, the MAPP Steering Committee sent
invitations to 82 individuals from the community representing a broad spectrum of professions,
interests and human services. The meeting was held on August 10, 2009 at the Columbia-Greene
Community College and led by the MAPP staff and facilitated by an Extension Educator with Cornell
Cooperative Extension of Columbia County. Participants were asked to consider their responses to the
following three questions:
 What does a “healthy” Columbia County look like to you?
 What do you feel would make Columbia County a healthier place to live, work and play?
 What changes would you recommend to improve the health of our community in the next 2, 5
or 10 years?
Initially there was a large group brainstorming session followed by small group work. The large group
reconvened and the end product was a lengthy list of answers to the three questions.
Following this meeting a smaller sub-group of the MAPP Steering Committee met to review the ideas
represented in the answers to the three questions and to group these ideas into similar categories.
Taking these ideas and processing them, the sub-group developed a draft Vision Statement that would
be presented to the larger group on November 4, 2009. After a few suggestions/changes the following
vision statement emerged:
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COLUMBIA COUNTY MAPP PROJECT
COLUMBIA COUNTY VISION STATEMENT
“A healthy community is clean, safe and has ready access to health care and all needed human
services. Community awareness, diversity and development are strengthened through
knowledgeable, engaged and nurturing involvement by many citizens and leaders who value
our population and usable resources, and support physical, mental, social, intellectual, and
spiritual well being. A healthy community has a strong Public Health System that includes:
planning and policy development, shared leadership among many community partners,
effective response to challenges, assessment and accountability, and which protects and
promotes the health of residents of all ages and the natural and community environments.”
The Columbia County Community Health Planning Initiative
The Visioning sub-group of the MAPP Steering Committee
The sub-group also identified the following community values:
To have a SAFE community committed to allocating needed resources to create a safe
environment where individuals feel no fear or threat to their personal well being. This is
a community where there is respect for the environment in recognition of the
connection between environmental health, mental health and physical health.
To have a KNOWLEDGEABLE and ENGAGED community where education is valued as
part of the decision-making process and that building a sense of community is a daily
activity.
To have a NURTURING, DIVERSE, and TOLERANT community where children are valued
and nurtured through strong family and community support. This is a community where
understanding and respect of cultural differences enhances the community and each
resident has the opportunity to live their life to the fullest with equal opportunity for all.
To have a community where ACCESS to HEALTH CARE is a top priority. This is a
community where quality health care is accessible to all residents, including the indigent
and underserved, and is not taken for granted, but is valued with a focus on prevention
and respect for our bodies.
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COLUMBIA COUNTY MAPP PROJECT
Phase III – The Four MAPP Assessments
Description and Purpose
Assessment is one of the core functions of public health. It gives a picture of the status of the
community and is used to inform planning and policy-making. In the MAPP process four assessments are
used to give a broader view of the community and what the perception of the quality of life is. It also
allows for more community voice and participation in the strategic planning process. Each assessment is
done independently of the other. The results from all four assessments are then used to assist the MAPP
Steering Committee in the identification of strategic issues in Phase IV.
Community Involvement
Community involvement is pivotal to making the MAPP process work. Many people were recruited to
join the four assessment teams who worked diligently over a period of several months. MAPP Steering
Committee members were intimately involved in at least one team to ensure good communication back
and forth between the assessment team and the MAPP Steering Committee.
Process
A kick-off meeting was held on March 23, 2010 at Cornell Cooperative Extension of Columbia County.
The community assessment phase of MAPP was introduced. It was stressed that assessments would
consider community values and strengths, the public health network and delivery of health services,
priority health and quality of life issues and forces of change that effect (will effect) community health.
Participants learned that data gathered through these assessments would be used to identify and
prioritize issues, and then form goals and strategies in the coming phases of the planning process.
People self-selected into four teams according to their interest and areas they represented. The four
assessment teams made meeting plans and chose chair people. The four assessments conducted were:
the Community Health Status Assessment; the Community Themes and Strengths Assessment; the
Local Public Health System Assessment (LPHSA); and the Forces of Change Assessment.
Community Themes and
Strengths Assessment: identifies
themes that interest and engage
the community, perceptions
about quality of life, and
community assets
Local Public Health System
Assessment: measures the
capacity of the local public
health system to conduct
essential public health services
Forces of Change Assessment:
identifies forces that are
occurring or will occur that will
affect the community or the
local public health system
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Community Health Status
Assessment: analyzes data about
health status, quality of life, and
risk factors in the community
COLUMBIA COUNTY MAPP PROJECT
The Community Health Status Assessment: The CHS identifies priority issues related to community
health and quality of life. Questions answered during this phase include: “How healthy are our
residents?” and “What does the health status of our community look like?” On the following pages is a
summary of these findings.
Columbia County Community Health Planning Initiative
Community Health Status Assessment
The Community Health Status Assessment Committee of the local MAPP (Mobilizing for Action
through Planning &Partnership) activity has been working to make determinations regarding the
health status of the community. Data has been gathered from the CCDOH Community Health
Assessment 2010 and other local, state and national sources for the purpose of describing local
health conditions - see the “Columbia County Community Health Profile”. Further, this assessment
seeks to identify the community public health priorities that are most challenging among the
needs of the population. MAPP seeks to consider the effectiveness of the local public health
system and use of resources. We believe there exists opportunities to improve in these areas, as
we continue addressing public health issues where desired outcomes are resulting from strategies
already underway.
MAPP is a community-wide strategic planning tool for improving public health. It is a method to
help communities prioritize public health issues, identify resources for addressing them, and take
action. Attached is a summary of information and data gathered to present a picture of the health
status of Columbia County. Below are listed health priorities identified by the committee, and
some description of the issues & concerns associated with them. As we call attention to these
aspects of community health status, we expect they point to specific needs that will be addressed
in the coming Strategic Planning phases of the MAPP activity of the Columbia County Community
Health Planning Initiative.
_________________________________________________________________________
Health Insurance – It’s estimated that 20 % or more of the population lacks coverage, enrollees
may not take full advantage of coverage (high co-pays, fail to follow recommendations for care)
some providers may not accept public (Medicaid) or other health plan coverage. The “Affordable
Care Act” federal medical coverage plan will have effects on health insurance coverage and the
health care system as well.
Primary Care Provider – Lack of a medical home is estimated for 25% of the population, which
greatly effects preventive care and access to care; providers may be challenged by health care
economics and sufficient health care workforce needs to meet all patient and community needs
throughout the county. Specialty care poses accessibility challenges for segments of the
population including OB services which for 50% of pregnancies care is obtained outside of the
county.
Dental Care – Lack of insurance, lack of providers, providers selective acceptance of insurances,
education & outreach needed to improve child & family dental care habits; adult dental care –
significant needs, but data and resources lacking. In Columbia County, 3rd graders have a higher
rate of tooth decay and untreated caries than the New York State average. NYS Bureau of Dental
Health has a new request for proposal (RFP) for a 5-year preventive dental program to apply
sealants to prevent tooth decay and provide oral health education to elementary children, which
could be a resource in this county if a local entity would be ready to engage in this program.
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COLUMBIA COUNTY MAPP PROJECT
According to the NYU College of Dentistry, they see a significantly high number of adults with long
standing decay during their Hudson adult dental outreach activities. They have not collected data,
but will do so during future visits.
Pregnancy Care & Reproductive services, Pregnancy Prevention – teens, young adults; target
areas include Hudson, Philmont and rural pockets, and youth in general for prevention or
abstinence.
Mental Health / Substance Abuse - substance abuse, ETOH related injury (auto) and negative
behaviors, suicide rate increasing, domestic violence, gambling. Regionalization of mental health
services may decrease access.
Family & Youth Services - support of families economic and social including health care, single
parents need greater support, high percentage of children placed in foster care in Columbia
County compared to NYS data.
Tobacco related disease - CA lung, CLRD, and asthma. Tobacco use and dependence is the leading
preventable cause of morbidity and mortality in New York State and in the US. Cigarette use alone
results in an estimated 25,500 deaths in New York State. In Columbia County, 24.7% of adult
residents are current smokers compared to the state rate of 17.0 adult smokers. Cigarette
smoking is the main cause of lung cancer and Chronic Obstructive Pulmonary Disease, the 2nd and
3rd leading causes of mortality in the county. Any attempt to improve lung cancer mortality and
chronic lower respiratory disease death rates will need to address the issue of smoking, especially
in adolescents and households with incomes under the $50,000 range (as identified in the
Healthcare Consortium study). Second Hand Smoke is an important contributor as well to
problems related to cigarette smoking and often affects the health and well being of children.
Cigarette smoking also carries with it an economic impact as the cost of cigarettes is considerable
and effects personal & family resources. Likewise, the higher incidence of asthma related hospital
admissions in the Hudson area may be linked to smoking rates. Fifty percent of hospital
admissions for asthma related issues come from the Hudson area. Further investigation into this
matter is recommended.
Environmental Issues – radon and fluoridation of water supply. The fluoridation of Columbia
County’s water supply will reduce the rate of tooth decay in children and adults. According to the
Public Health Reports/ September–October 2010 / Volume 125, an evaluation was conducted to
determine if the number of NYS Medicaid claims reimbursed for caries-related procedures for
children varied by counties with or without fluoridated water. The number of claims for children
in each county was calculated separately for the treatment of caries and all other procedures not
related to caries using the 2006 Medicaid claims data. The results were that the number of
restorative, endodontic, and extraction procedures per recipient was 33.4% higher in less
fluoridated counties.
Radon, either as an indoor air pollutant or in drinking water is a serious health threat. Radon
exposure can damage lung tissue and ultimately lead to lung cancer. Columbia County has a
significantly higher level of indoor radon than the state as a whole. Specific towns within the
county have even greater exposure levels. Over 100 homes in the high risk areas (Copake,
Philmont/Mellenville, Kinderhook/Valatie and Ancram) have been tested and a few assisted with
mitigation. Increased education, funding, research and assistance for mitigation efforts should be
pursued.
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COLUMBIA COUNTY MAPP PROJECT
Diabetes - obesity, unhealthy diets / lack access to healthy foods (fruits and vegetables), and lack
of physical activity.
Heart Disease - The leading cause of mortality in Columbia County is attributed to diseases of the
heart. However, the age-adjusted rate of death due to heart disease is comparable to New York
state averages and trending toward improvement. Over the past decade, the assistance of
programs like Healthy Heart and a focus on healthier lifestyles may have contributed to a
decreasing rate of death due to diseases of the heart in the county. These efforts need to
continue to ensure both the quality of life and longevity of our population.
One area of specific concern related to heart disease, however, is the high rate or pre-transport
mortality. Compared to statewide averages, Columbia County has significantly higher rates of pretransport mortality for all heart and cerebrovascular diseases. Identifying and addressing the
cause of pre-transport mortality is critical.
Injury - The rate of motor vehicle accidents and unintentional injury among 15-24 year olds within
the county is worrisome. New laws for inexperienced drivers may help to curb the rate of
accidents. Additional alcohol & substance abuse education and counseling may also improve
outcomes.
Of additional concern, is the increased rate of hospitalizations and mortality among those young
people who are 15-24 years old. Columbia County rate of unintentional injury hospitalizations for
the 15-25 year olds is 51.6 compared to the NYS rate of 34.9. Unfortunately, data for these
hospitalizations is not complete. Data for location of injury is unspecified and/or missing in 74.7%
of Columbia County Emergency Department (ED) visits compared to NYS 34.5%. If this trend
continues, the ED has indicated that it would be willing to pursue a snapshot in time survey for
approximately four weeks to identify the source of injury in this age group.
Transportation - limited or lack of transportation services county-wide - medical, human service,
food shopping, etc.
Communicable Disease - Flu immunization for all ages – implement new child recommendations
& better rates for adults and health care workers, timely child & adult immunization, Lyme
disease including chronic symptoms and treatment, STD/HIV.
Housing – lack of affordable housing, homelessness, lead exposure risk in older homes
Health Literacy – need for health education for lower socio-eco groups and cultural sub-groups;
need for countywide health education coordination/partnership; need for awareness/motivation
for preventive care and healthy behaviors, and increased understanding of recommendations and
importance for follow-up for specific medical conditions & care; and cultural and language
barriers.
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COLUMBIA COUNTY MAPP PROJECT
The Community Themes and Strengths Assessment: provides a deep understanding of the issues
that residents feel are important by answering the questions: “What is important to our
community?” “How is quality of life perceived in our community?” and “”What assets do we have
that can be used to improve community health?”
The sub-committee assigned to conduct this assessment decided to develop a survey and conduct
it randomly with about 60 people. The purpose of the survey was to gather the opinions of
community members about conditions and concerns related to the quality of life and well-being of
Columbia County residents.
The top six issues relating to quality of life were:
Tolerance
Safe neighborhoods
Affordable housing
Access to health care
Good jobs and healthy economy
Strong family life
The top six issues relating to perceived health problems were:
High blood pressure
Obesity
Diabetes
Cancers
Heart disease and stroke
Dental problems
The top six behaviors causing problems in the community are:
Tobacco use
Teen drug use
Adult drug use
Underage drinking
Unsafe sex
Adult alcohol abuse
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COLUMBIA COUNTY MAPP PROJECT
The Local Public Health System Assessment (LPHSA): Traditionally, many people think of the local
health department as the public health system in the community. However, it is important to think of
the public health system as many organizations (private, public, and voluntary entities) and individuals
that engage in activities contributing to the delivery of the ten essential services of public health.
Consider these complex relationships in the diagram below:
Local Public Health System
PUBLIC HEALTH in AMERICA
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COLUMBIA COUNTY MAPP PROJECT
(LPHSA continued)
The purpose of engaging in this assessment is to measure the performance of the local public health
system. In addition to measuring the overall system performance, the National Public Health
Performance Standard Program (NPHPSP) tool assesses the contribution of the local health department.
The LPHSA helps to answer the questions:
1. What are the activities and capacities of our public health system?
2. How well are we providing the Essential Public Health Services in our county?
The NPHPSP assessment tool was used to evaluate the system. The program is used throughout
the United States. It was developed in 2001 as a collaboration of the Center of Disease Control
(CDC) and the National Association of County and City Health Officials (NACCHO). The NPHPSP
tool is based on the framework of the ten Essential Public Health Services (EPHS), not individual
organizations.
*************************************************************************************
Essential Public Health Services (EPHS)
1. Monitor Health status to identify community health problems.
2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people to needed personal health services and assure the provision of health care when
otherwise unavailable.
8. Assure a competent public health and personal health care workforce.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
10. Research for new insights and innovative solutions to health problems.
The NPHPSP was conducted in August of 2010 over the course of three separate meetings held at the
Human Services Building in Hudson. We involved twenty-six public health professionals from the county
representing government, health care, education, non-profits, clergy, corrections, and the private
sector. During the meetings, each Essential Public Health Service, model standard and indicator question
was reviewed, discussed and scored. Data was submitted to CDC and a report was received within 24
hours. A follow-up meeting was scheduled for October 2010 to review the findings. On the following
page you will find the Summary of Essential Public Health Service (EPHS) Scores for Columbia County.
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COLUMBIA COUNTY MAPP PROJECT
Summary of Essential Public Health Service (EPHS) Scores
EPHS
1
2
3
4
5
6
7
8
9
10
Score
Monitor Health Status To Identify Community Health Problems
Diagnose And Investigate Health Problems and Health Hazards
Inform, Educate, And Empower People about Health Issues
Mobilize Community Partnerships to Identify and Solve Health Problems
Develop Policies and Plans that Support Individual and Community Health Efforts
Enforce Laws and Regulations that Protect Health and Ensure Safety
Link People to Needed Personal Health Services and Assure the Provision of Health Care when
Otherwise Unavailable
Assure a Competent Public and Personal Health Care Workforce
Evaluate Effectiveness, Accessibility, and Quality of Personal and Population-Based Health Services
Research for New Insights and Innovative Solutions to Health Problems
Overall Performance Score
56
79
59
46
72
72
71
55
69
60
64
The MAPP Steering Committee decided to include the four Essential Public Health Services which
ranked below 60% in the information to be used for the identification of strategic issues. They are:
EPHS #4
Mobilize Community Partnerships to Identify and Solve Health Problems: 46%
1. Community health improvement committee: 0
2. Review of community partnerships and strategic alliances: 25
3. Communications strategies to build awareness of public health: 44
EPHS #8
Assure a Competent Public and Personal Health Care Workforce: 55%
1. Identification of shortfalls and/or gaps within the LPHS workforce: 50
2. Dissemination of results of the workforce assessment/gap analysis: 0
3. Educational and training incentives: 50
4. Recruitment and retention of new and diverse leaders in Public Health L:eadership
Development: 25
EPHS #1
Monitor Health Status to Identify and Solve Community Health Problems: 56%
1. Community-wide use of community health assessment or CHP data: 25
2. State-of-the-art technology to support health profile databases: 38
3. Access to geo-coded health data:25
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COLUMBIA COUNTY MAPP PROJECT
EPHS #3
Educate/Empower/Inform people About Health Issues: 59%
1. Collaboration on health communication plans: 44
2. Development of health communication plans: 40
3. Crisis and emergency communications training:25
The Forces of Change Assessment: The forces of change assessment focuses on identifying forces
such as legislation, technology, and other impending changes that affect the context in which the
community and its public health system operate. This answers the questions: “What is occurring
or might occur that affects the health of our community or the local public health system?” and
“What specific threats or opportunities are generated by these occurrences?”
The Forces of Change Assessment Sub Committee met on November 16, 2010. They were asked to
think about forces of change – outside of their control – that affect the local public health system
or community. The following questions were given to assist in the thought process:
1.
2.
3.
4.
5.
6.
What has occurred recently that may affect our local public health system or community?
What may occur in the future?
Are there any trends occurring that will have an impact? Describe the trends.
What forces are occurring locally? Regionally? Nationally? Globally?
What characteristics of our jurisdiction or state may pose an opportunity or threat?
What may occur or has occurred that may pose a barrier to achieving the shared vision?
The Forces of Change in Columbia County, as identified by the committee, are:
Disease:
Lyme Disease
Lead Poisoning
Transportation:
Lack of transportation; public and
personal
Closing of rural clinics
Influx from NYC
Catastrophic Event – TSP
Deteriorization of infrastructure
Healthcare Education and Awareness:
Increased recycling
Funding for broadband access
Electronic health records
Improved use of technology
Devaluation of healthcare
services/professionals
Increased enrollment in
community colleges
Increased identification of special
needs
Health care education and
awareness
Lack of psychiatrists/pediatricians
Food safety/recalls
Safe and Affordable Housing:
Lead poisoning
Lack of affordable housing
Obesity:
Lack of access to healthy,
affordable food
Lack of recreational trails
Widening obesity
Cost of food
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COLUMBIA COUNTY MAPP PROJECT
Federal Health Reform
Ethnic Population
Federal health reform
Decreased ability to serve ununder-insured
Decreased government funding
Lack of funding for prevention
Lack of funding for off-site
services
Racial and cultural barriers
Immigrant population distrust
From migrant to resident
State Funding
Regionalization and consolidation
of services
Increased funding for HEAP
New Governor, elected officials
Reduction in state aid
Need buy-in from local politicians
No response from state for
identified gaps
Suicide and Mental Health
Service gaps: in-patient mental
health
NIMBY factor for Mental Health
Law enforcement follow up for
mental health
Lack of family resources, no
support network
Increased suicides
Others
Silos: lack of partnerships
Increase in pay per service
Urban vs. Rural
Lack of affordable dental services
Climate change, drought potential
Bedroom between NYC and
Albany
Fluoridating water
Jobs and Training
Job works program; jobs for
different cultures
Need work force training for 3050 yr-olds.
Lack of manufacturing
Decline in farm-based jobs
Increased homelessness
Increased foreclosures
“Public Health is
what we as a
Family Support and Resources
society do
Disparity between haves and
have-nots
Lack of hope
Increased identification of special
needs
Decline and consolidation of
religious services
Insufficient discharge planning
Agricultural community coming
together
collectively to
assure the
conditions in which
people can be
healthy.”
Institute of Medicine, 1988
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COLUMBIA COUNTY MAPP PROJECT
Phase IV – Identifying Strategic Issues (Setting Priorities)
Description and Purpose
During this phase of the MAPP Process, participants develop an ordered list of the most important
issues facing the community. Strategic issues are identified by reviewing the results of the four MAPP
assessments, identifying recurring themes, issues and ideas, and determining how those issues affect
the achievement of the shared vision.
Community Involvement
The community was engaged in the strategic issues phase at three different meetings. We established a
THINK TANK, which consisted of a small number of people from the greater MAPP Steering Committee.
The THINK TANK and the MAPP Steering Committee were the driving forces behind the development of
the final list of strategic issues.
Process
On June 21, 2011, the THINK TANK assembled to sift through the issues that were common to all four
areas of the assessment phase. After much discussion, the members were asked to identify “their”
individual top five issues.
MAPP staff assembled a list of the top common issues identified by members of the THINK TANK.
On June 27, 2011, the Columbia County MAPP Steering Committee met in a half day strategic issues
planning session facilitated by Columbia County Health Department Staff. Staff presented an overview
of the data provided and then issued a charge to the committee members. The charge was to “Build A
Campaign” for the issue they felt strongest about and to make a case for why that issue should be one
of the final four or five selected.
Participants’ self-assigned to groups based on the interest and expertise they brought to the table. Each
group was given a “Build a Campaign for your Strategic Issue” worksheet to guide and record their
discussion. Copies of the assessments and other supporting resources were provided to each team.
The following criteria, suggested by NACCHO, were used to determine if the issue was strategic:
Issue is grounded in data from MAPP assessments
Issue is forward thinking
Issue is cross cutting
Issue seizes on current opportunities
Issue represents a fundamental choice to be made at the highest levels of the community and
local public health system.
Issue centers on a tension or conflict to be resolved
Issue may have no obvious solution
Issue is something the local public health system can address
Issue requires multi-sector, collaborative approach
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COLUMBIA COUNTY MAPP PROJECT
The small groups reported back to the larger group to review their groups’ work. With some creativity
and consensus building, the following strategic issues were identified (along with related sub-issues):
1. Chronic Disease Prevention (nutrition, physical activity, and specific issues such as heart health,
diabetes, cancer, arthritis, COPD, lung health and dental health.)
2. Mental Health and Substance Abuses (alcohol use/abuse, vehicle accidents, death rates, binge
drinking, drug use/abuse, tobacco use/abuse.)
3. Community Partnerships
4. Access to Quality Primary Care (dental health, maternal/child health, mental health,
prevention/treatment of chronic disease.)
5. Jobs/Workforce
On August 10, 2011, the THINK Tank met to provide another opportunity for input regarding the
identified strategic issues and gave their final approval.
Summary of Key Findings
Seventeen potential strategic issues were identified during the MAPP Steering Committee Meeting.
Following the group discussion and subsequent THINK TANK meeting, the participants identified the
following five strategic issues:
Chronic Disease Prevention and Management
Mental Health and Substance Abuses
Community Partnerships
Access to Quality Primary Care
Workforce Development
Members agreed to meet in small groups during September to begin the process of Formulating Goals
and Strategies (Phase V) for each of the issues.
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COLUMBIA COUNTY MAPP PROJECT
Phase V – Formulate Goals and Strategies
Description and Purpose
The fifth phase in the MAPP process is setting goals and formulating strategies for the strategic issues
identified in Phase IV. Goals and strategies provide a connection between the current reality (what the
local public health system and community look like now) and the vision (what the local public health
system and community will look like in the future). Together, the goals and strategies provide a
comprehensive picture of how local public health system partners will achieve a healthy community.
Community Involvement
Small strategic issues work groups were established to continue with Phase V of the MAPP Process. The
groups were a combination of self-selected individuals from the MAPP Steering Committee and some
who were from the community and identified by the MAPP Steering Committee.
Process
During September 2011, these small work groups convened for the purposes of formulating goals and
strategies for the Strategic Issues established in Phase IV.
At each of the meetings, the MAPP staff used the following agenda:
1.
2.
3.
4.
5.
6.
Reviewed the process for Phase 5 as defined on the NACCHO website.
A review of the Vision Statement and the definition of the Public Health System.
A review of the Strategic Issue
A RECAP of the assessment findings related to the particular strategic issue.
A review of a sample from another county
Work session brainstorming goals and strategies, along with potential barriers.
The MAPP staff then reworked the draft document and emailed it to the small group members for final
approval. If an additional meeting was deemed necessary, it was scheduled and held. The final
documents were then produced and forwarded to the MAPP Steering Committee.
In mid-October the MAPP Steering Committee assembled and gave final approval to the goals and
strategies developed by the small groups.
These goals and objectives will serve as the foundation for the work to be completed in Phase VI - The
Action Cycle.
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COLUMBIA COUNTY MAPP PROJECT
Priority Concern ONE: Chronic Disease Prevention and Management
Strategic Issue: How can the Public Health System in Columbia County work together to empower,
educate and motivate Columbia County residents to lead a healthy lifestyle?
Goals
1. Improve the physical health and nutritional behaviors of Columbia County residents in a
culturally sensitive approach through education at the grassroots level.
2. Improve the overall dental health of Columbia County residents.
3. Increase the number of people who are screened for chronic disease symptoms.
Suggested Strategies for Goal #1
Implement a comprehensive selection of programs for all Columbia County residents to educate them
about chronic disease prevention and management. Research best practices to identify appropriate
curriculum for training public health educators to include but not be limited to nutrition education and
basic cooking programs promoting low calorie, low fat, low sodium and low cost meal preparation,
teaching label reading, and encouraging greater consumption of fruits and vegetables and whole grains.
Support policy change that reduces exposure to second-hand smoke, makes tobacco products less
accessible and less visible, and makes tobacco use more expensive, less convenient and less socially
acceptable.
Support policy change that limits/regulates alcohol outlet density to decrease excessive alcohol
consumption and related harms.
Implement the Healthy Restaurant Program to increase the availability of low fat, low sodium, nutrient
dense and low cost menu options for the general public.
Propose possible policy changes to decision makers: for example, sweetened beverage tax or
mandatory calorie posting for menu items at restaurants and fast food places in Columbia County.
Provide more local support for Farmer’s Market programs and community gardens.
Establish various theme-oriented campaigns such as No Sugar Sweetened Beverages, No Junk Food
Campaign and Family Meals Campaign.
Establish nutrition education programs such as Healthy Heart, Five-A-Day, Low Sodium and Low Fat
Cooking, Label Reading, Diabetes Management, Exercise Programs for Different Ages and Stages, and
Planning Meals on a Budget.
Create or enhance access to places in community for physical activity combined with informational
outreach activities. Embrace “Complete Streets” in Columbia County.
Utilize point-of-decision prompts throughout the county to encourage use of the stairs.
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COLUMBIA COUNTY MAPP PROJECT
Suggested Strategies for Goal #2
Increase access to dental health services, in particular those who will receive Medicaid.
Promote and support community water fluoridation to reduce tooth decay, especially among children.
Promote and support school-based and school-linked dental sealant delivery programs to prevent or
reduce tooth decay among children.
Suggested Strategies for Goal #3
Research best practices for comprehensive worksite wellness programs and utilize these to implement
worksite wellness programs focused on healthy lifestyles and chronic disease prevention/management.
Partner with health insurance providers serving Columbia County residents to maximize health benefits
in order to live a healthy lifestyle.
*************************************************************************************
Priority Concern TWO: Mental Health and Substance Abuses
Strategic Issue: How can the Public Health System in Columbia County ensure that all individuals are
appropriately screened, referred and have access to mental health and substance abuse services and
programs?
Goals
1. Increase use of screening tools by physical healthcare professionals to identify cross system
treatment needs related to mental health and/or substance use/abuse (including tobacco and
prescription medications.)
2. Increase referrals and access to age appropriate and culturally sensitive mental health and
substance abuse services.
3. Increase awareness of behavioral health as an important component of overall wellness and
safety.
4. Reduce the stigma associated with mental illness and substance abuse disorders to enable
people to access needed services.
Suggested Strategies for Goal #1
Work with physical healthcare professionals in implementing cross system screening tools which identify
treatment needs outside their scope of practice.
Work with existing networks such as the Columbia County Community Services Board and its
subcommittees, Mental Hygiene Network and Healthcare Consortium to coordinate mental health,
physical health and substance abuse treatment.
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COLUMBIA COUNTY MAPP PROJECT
Suggested Strategies for Goal #2
Work with physical healthcare professionals in developing cross system referral processes with follow
through to improve access to mental health and substance abuse services.
Develop a resource “pocket card” for professionals to distribute to patients/clientele.
Suggested Strategies for Goal #3
Work with the Rip Van Winkle Tobacco Free Action Initiatives to eliminate/reduce smoking in indoor and
outdoor living spaces.
Create mass media campaign to raise awareness, inform and educate the general population about the
broad range of consequences related to untreated behavioral healthcare issues with an emphasis on
prevention and treatment.
Create prevention programs which target the physical health issues common to the mental health and
substance abuse populations (i.e. use of tobacco products and related respiratory diseases, diabetes,
obesity, etc.)
Support local law enforcement and the courts to enforce underage drinking laws, motor vehicle
DWI/DUI laws and boating BWI/BUI laws.
Suggested Strategies for Goal #4
Create mass media campaign to raise awareness, inform, and educate the general population about the
broad range of consequences related to untreated behavioral healthcare issues with an emphasis on
prevention and treatment.
Work with the Columbia County Community Services Board and its subcommittees to improve access to
mental health and substance abuse services by identifying and removing actual and perceived barriers.
*************************************************************************************
Priority Concern THREE: Community Partnerships
Strategic Issue: How can the Columbia County Public Health System improve the delivery of all essential
health services through collaborations and partnerships to maximize services and programs?
Goals
1. Establish and nurture community partnerships and strategic alliances to assure a comprehensive
approach to improving health in the community and to maximize public health improvement
activities.
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COLUMBIA COUNTY MAPP PROJECT
2. Educate stakeholders and decision-makers as to the role they need to play in helping Columbia
County residents be healthy.
Suggested Strategies for Goal #1
Conduct a comprehensive assessment of programs being held in the county. Identify if they are
mandated, the strengths and the weaknesses of the programs, and how they are governed.
Organize and hold an annual “Interagency Awareness Day” to promote networking and collaboration
among community agencies and programs.
On a quarterly basis, organize and hold community forums/roundtables around a common theme to
discuss current issues and events.
Publish an electronic directory of Public Health Programs and Services that would be available to the
General Public and update it annually.
Suggested Strategies for Goal #2
Establish a broad-based Columbia County Public Health Improvement Committee/Alliance that will meet
regularly to oversee the coordination and delivery of necessary health care services to achieve the
overall goal of community health improvement by monitoring and evaluating progress toward
prioritized goals. This group will meet to get behind issues, educate the community and stakeholders,
bring a “strong voice” when needed, and to assist with the development and implementation of a
County dashboard.*
Educate and inform the county Board of Supervisors to empower them to take some financial
responsibility for the health of Columbia County residents.
Train appropriate staff in the curriculum, “Building Buy-In: How to Mobilize, Inspire and Sustain
Community Projects” to prepare them to work with decision makers and stakeholders.
A dashboard is a web site that organizes information so that it is easy to read and interpret. It also
provides up-to-date status information on critical issues.
*************************************************************************************
Priority Concern FOUR: Access to Quality Primary Care
Strategic Issue: How can the Columbia County Public Health Care System assure access to affordable
primary care for its residents?
Goals
1. Columbia County residents will have access to affordable primary care services, particularly the
under-insured and uninsured.
2. Improve the health literacy levels of Columbia County residents, empowering them to take
charge of their health and to have a health care home
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COLUMBIA COUNTY MAPP PROJECT
3. Improve access to early prenatal care to improve birth outcomes and reduce the infant
mortality rate.
4. Increase the percentage of children screened for lead during the first two years of their life.
Suggested Strategies for Goal #1
Promote existing healthcare plans and programs for limited-income, under-insured and uninsured
Columbia County residents.
Explore the option of establishing a Healthy Families Resource Center, with several satellite offices
around the county, to conduct health screenings, education and counseling programs, and mental
health services OR explore the option of having a mobile health education and care unit to cycle around
the county to meet the needs of residents in the outer rural areas.
Provide residents with a consistently updated directory of primary care and dental offices available in
Columbia County who are receiving new patients and patients on Medicaid.
Recruit dentists around Columbia County to take Medicaid patients.
Utilize the Public Health System Leadership Team to oversee progress in assurance of access to primary
and dental care in the county.
Explore transportation issues for target populations and develop possible solutions.
Suggested Strategies for Goal #2
Assist Columbia County residents in understanding the importance of having a primary health care
provider in order to reduce overall health care costs and to obtain optimal personal health.
*************************************************************************************
Priority Concern FIVE: Workforce Development in the Healthcare System
Strategic Issue: How can the Columbia County Public Health System strengthen and support the
capacity of the Public Health Workforce?
Goals
1. Organizations within the Columbia County Public Health System must develop and maintain
public health workforce standards for workers who deliver and/or contribute to the Essential
Public Health Services.
2. Incorporate into personnel services the core and specific competencies that are needed to
provide the Essential Public Health Services.
Suggested Strategies for Goal #1
Expand educational and training opportunities for current and future health care professionals.
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COLUMBIA COUNTY MAPP PROJECT
The Public Health Leadership Team will:
Regularly examine the changing demographics of the workforce and respond accordingly.
Conduct employee surveys of staff satisfaction, training needs, retentions issues, etc. on an
annual basis.
Systematically and spontaneously recognize Public Health System staff accomplishments.
Reduce commonly known barriers to successful recruitment and satisfactory retention of quality
health care workers.
Suggested Strategies for Goal #2
Educate both the general public and healthcare professional about what public health is and the 10
Essential Health Services as identified by the Center for Disease Control.
Public health professionals need to align and lead the local government and general public on major
health issues in the community, assisting them in seeing these as high priorities.
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Phase VI – Action Cycle
Description and Purpose
The Action Cycle links three key activities – planning, implementation, and evaluation. Each of these
activities builds upon the others in a continuous and interactive manner. The Action Cycle may be the
most satisfying and challenging phases of the MAPP process. It is during this phase that the efforts of
the previous phases begin to produce results. This is when the local public health system develops and
implements an action plan for addressing the strategic issues. It is also when it becomes increasingly
important to sustain the process and continue implementation over time. The Action Cycle can be
summarized as follows:
Planning: what will be done, who will do it, and how it will be done.
Implementation: carrying out the activities identified in the planning stage.
Evaluation: determining what has been accomplished.
In researching Community Health Improvement Plans from across the country, it is noted that many of
them did not include Phase VI—the Action Cycle. This is probably with good reason in that the Action
Cycle is cumbersome and time consuming. The planning component, which involves organizing for
action, developing objectives and establishing accountability, and developing action plans has been
largely accomplished in Phase V. However, the implementation component, which involves review of
action plans for opportunities for coordination, implementation of action plans and monitoring of action
plans, and the evaluation component, which involves preparing the evaluation activities, designing the
evaluation, gathering credible evidence, justifying conclusions, sharing lessons learned and celebrating
successes all require a great deal of person and time commitment. This alone can be a major barrier for
moving ahead with completion of the Action Cycle.
Community Involvement
One of the themes we found throughout the writing of each of the strategic issues was that the
development of a Public Health Leadership Team in Columbia County would be a beneficial step to take
for the purposes of providing leadership in the planning for action of the goals of highest importance to
improving the quality of life for the residents of Columbia County. This group could provide leadership
for the Action Cycle as described above.
Process
On January 18, 2012, we had an organizational meeting of people from the MAPP Steering Committee
and THINK TANK who had an interest in examining the development of a Public Health Leadership Team.
After discussions about organizational structure, tasks, meeting dates, and leadership, it was decided to
move forward with the activity of prioritizing the 80 strategies identified in the Community Health
Improvement Plan and to put the organizational questions on the back burner for the time.
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Starting on February 6, 2012, Kary Jablonka, Executive Director from the Columbia County Office for
Aging, took leadership in running us through a series of ranking activities resulting in the following Top
Five strategies for 2012:
Work with existing networks such as the Columbia County Community Services Board and its
subcommittees, Mental Hygiene Network and Healthcare Consortium, to coordinate mental
health, physical health and substance abuse treatment services and programs, and to improve
access by identifying and removing actual and perceived barriers as well as the newly formed
Columbia County Public Health Leadership Team.
Promote and support school-based and school-linked dental sealant delivery programs to
prevent or reduce tooth decay among children; promote educational programs focusing on
early education for dental care such as “Brush from the Start,” and campaigns on proper bottle
use; and increase lead screening. All are early childhood focused.
Research best practices for comprehensive worksite wellness programs and utilize these to
implement worksite wellness programs focused on healthy lifestyles and chronic disease
prevention/management; using the evidence based information from The Community Guide,
develop recommendations for worksite-based interventions to improve workers’ health. The
Task Force from The Community Guide recommends the use of assessments of health risks with
feedback when combined with health education programs to produce identified outcome
measures among workers. Conduct worksite wellness programs throughout the county on a byrequest system. All are worksite wellness focused.
Educate and inform the county Board of Supervisors to empower them to take some shared
responsibility for the health of Columbia County residents
Promote existing healthcare plans and programs for limited-income, under-insured and
uninsured Columbia County residents.
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APPENDIX A:
10 Essential Public Health Services
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PUBLIC HEALTH FUNCTIONS AND TEN ESSENTIAL SERVICES
Public health encompasses three core functions: assessment of information on the health of a
community, comprehensive public health policy development, and assurance that public health services
are provided to the community. These functions have been defined further and expanded into 10
essential public health services.
The 10 Essential Services
Monitor health status to identify and solve community health problems: This service includes accurate
diagnosis of the community’s health status; identification of threats to health and assessment of health
service needs; timely collection, analysis, and publication of information on access, utilization, costs and
outcomes of personal health services; attention to the vital statistics and health status of specific-groups
that are at higher risk than the total population; and collaboration to manage integrated information
systems with private providers and health benefit plans.
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Diagnose and investigate health problems and health hazards in the community: This service includes
epidemiological identification of emerging health threats; public health laboratory capability using
modern technology to conduct rapid screening and high volume testing; active infectious disease
epidemiology programs; and technical capacity for epidemiological investigation of disease outbreaks
and patterns of chronic disease and injury.
Inform, educate, and empower people about health issues: This service involves social marketing and
targeted media public communication; proving accessible health information resources at community
levels; active collaboration with health care providers to reinforce health promotion messages and
programs; and joint health education programs with schools, churches and work sites.
Mobilize community partnerships and action to identify and solve health problems: This service
involves convening and facilitating community groups and associations, including those not typically
considered to be health-related, in undertaking defined preventive, screening, rehabilitation, and
support programs; and skilled coalition-building ability in order to draw upon the full range of potential
human and material resources in the cause of community health.
Develop policies and plans that support individual and community health efforts: This service requires
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 as a part of continuous quality improvement strategies; joint evaluation with the medical
health care system to define consistent policy regarding prevention and treatment services; and
development of codes, regulations and legislation to guide the practice of public health.
Enforce laws and regulations that protect health and ensure safety: This service involves full
enforcement of sanitary codes, especially in the food industry; full protection of drinking water supplies;
enforcement of clean air standards; timely follow-up of hazards, preventable injuries, and exposurerelated diseases identified in occupational and community settings; monitoring quality of medical
services (e.g. laboratory, nursing homes, and home health care); and timely review of new drug, biologic
and medical device applications.
Link people to needed personal health services and assure the provision of health care when otherwise
unavailable: This service (often referred to as “outreach” or “enabling” services) includes assuring
effective entry for socially disadvantaged people into a coordinated system of clinical care, culturally and
linguistically appropriate materials and staff to assure linkage to services for special population groups;
ongoing “care management”; transportation services; targeted health information to high risk
population groups; and technical assistance for effective work site health promotion/disease prevention
programs.
Assure a competent public and personal health care workforce: This service includes education and
training for personnel to meet the needs for public and personal health service; efficient processes for
licensure of professional and certification of facilities with regular verification and inspection follow-up;
adoption of continuous quality improvement and life-ling learning within all licensure and certification
programs; active partnerships with professional training programs to assure community-relevant
learning experiences for all students; and continuing education in management and leadership
development programs for those charged with administrative/executive roles.
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Evaluate effectiveness, accessibility, and quality of personal and population-based health services:
This services calls for ongoing evaluation of health programs, based on analysis of health status and
service utilization data, to assess program effectiveness and to provide information necessary for
allocation resources and reshaping programs.
Research for new insights and innovative solutions to health problems: This service includes
continuous linkage with appropriate institutions of higher learning and research and an internal capacity
to mount timely epidemiological and economic analyses and conduct needed health services research.
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APPENDIX B:
The NYS Prevention Agenda Toward the Healthiest State
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The NYS Prevention Agenda toward the Healthiest State 2008-2013
The New York State Department of Health has launched a Prevention Agenda for the Healthiest State to
support the goals of health care reform. This agenda sets ten statewide public health priorities and asks
local health departments, hospitals and other community partners to work together to address them.
The emphasis of this public health initiative is on prevention strategies to improve the health of all New
Yorkers and foster healthy communities. Priority areas include:
Access to Quality Health Care
Chronic Disease
Community Preparedness
Healthy Environment
Healthy Mothers, Healthy Babies, Healthy Children
Infectious Disease
Mental Health and Substance Abuse
Physical Activity and Nutrition
Tobacco Use •
Rationale – Why Public Health?
Our health status is largely influenced by social circumstances, environmental conditions, behavioral
patterns and access to health care. Public health efforts directed at each of these factors can lower the
risk of adverse health outcomes. Primary prevention efforts promote healthy environments and
behaviors that lower the risk of disease among susceptible people. Secondary prevention focuses on the
early detection of diseases and conditions to enable a cure or better treatment outcome.
There is ample evidence that state and local spending on community-based primary and secondary
prevention can improve health outcomes and yield a return on investment through savings in health
care costs and Medicaid budgets.
Approach
The Prevention Agenda establishes goals for each priority area and defines indicators to measure
progress toward achieving these goals, including the elimination of racial, ethnic and socioeconomic
health disparities. The Prevention Agenda calls on local health departments and hospitals to identify two
or three of these priorities, and then work with community providers, insurers, community based
organizations and others to take action in addressing them. Each health department will undertake a
comprehensive Community Health Assessment and then develop a Municipal Public Health Services Plan
for the period 2010-2013. Hospitals will describe their operational commitment to meet community
needs in a Community Service Plan for a similar time period.
The Department is providing technical assistance on accessing county-specific data, using evidencebased prevention approaches, and monitoring their impact. Community-based efforts will be
complemented by local and statewide policy initiatives to help achieve the prevention goals.
More Information:
http://www.health.ny.gov/prevention/prevention_agenda/index.htm
Address: Office of Public Health Practice, 821 Tower Building, ESP, Albany, New York 12237
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APPENDIX C:
Community Health Plan for the Five Specific Strategic Issues
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Chronic Disease Prevention
Strategic Issue
How can the Public Health System in Columbia County work together to empower, educate and
motivate Columbia County residents to lead a healthy lifestyle?
Goals
1. Improve the physical health and nutritional behaviors of Columbia County residents in a
culturally sensitive approach through education at the grassroots level.
2. Improve the overall dental health of Columbia County residents.
3. Increase the number of people who are screened for chronic disease symptoms.
Relationship to Columbia County Vision
A healthy community has ready access to health care and all needed human services.
Support physical, mental, social, intellectual and spiritual well being
Protects and promotes the health of residents of all ages
Description of the Issue
Healthy eating is associated with lower risk for: chronic disease, such as Type 2 diabetes, hypertension,
heart disease and certain cancers; overweight and obesity; and micronutrient deficiencies. Nutrition
among the US population needs improvement. According to the CDC (Center for Disease Control), 63%
of the adult population nationally is overweight or obese and fewer than 25% of Americans eat fruits
and vegetables 5 or more times a day. The County Health Rankings published by the University of
Wisconsin Population Health Institute indicate only 52% of the residents in Columbia County have access
to healthy foods, with the National benchmark at 92% and the New York State rate at 61%.
Obesity in Columbia County is at 24% and this is about double from the past decade. Obesity contributes
to many chronic diseases (diabetes, heart disease, some forms of cancer, arthritis) and is itself
considered a chronic disease.
WIC data indicates a prevalence of tooth decay in third grade children is 61% higher than the NYS rate of
54%.
Tobacco use is the leading cause of preventable disease, disability and death. Tobacco use causes heart
disease, cancer and COPD in adults. In children, exposure to secondhand smoke causes coughs and
wheezing, bronchitis, asthma, pneumonia, respiratory tract infections, and eye and ear problems. The
primary source of exposure to secondhand smoke is the child’s home.
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The smoking rate in Columbia County, according to the HEAL 9 Report published by the Columbia
County Health Care Consortium, is about 23%, with higher rates among people who are less educated
and have less income, and among the age group 24-40.
Find below the objectives and strategies that have a direct link to the HP (Healthy People) 2020
objectives:
D-1
Reduce the annual number of new cases of diagnosed diabetes in the population
D-3
Reduce the diabetes death rate
AOCBC-1
Reduce the mean level of joint pain among adults with doctor-diagnosed arthritis
AOCBC-2 Reduce the proportion of adults with doctor-diagnosed arthritis who experience a limitation
in activity due to arthritis or joint symptoms
HDS-1
(Developmental) Increase overall cardiovascular health in the U.S. population
HDS-2
Reduce coronary heart disease deaths
HDS-3
Reduce stroke deaths
NWS-4 (Developmental) Increase the proportion of Americans who have access to a food retail outlet
that sells a variety of foods that are encouraged by the Dietary Guidelines for Americans
NWS-8
Increase the proportion of adults who are at a healthy weight
NWS-9
Reduce the proportion of adults who are obese
PA-1
Reduce the proportion of adults who engage in no leisure-time physical activity
PA-2 Increase the proportion of adults who meet current Federal physical activity guidelines for
aerobic physical activity and for muscle-strengthening activity
RD-9 Reduce activity limitations among adults with chronic obstructive pulmonary disease
(COPD)
RD-10
Reduce deaths from chronic obstructive pulmonary disease (COPD) among adults
RD-11
Reduce hospitalizations for chronic obstructive pulmonary disease (COPD)
RD-12
Reduce hospital emergency department visits for chronic obstructive pulmonary disease
TU-11
Reduce the proportion of nonsmokers exposed to secondhand smoke
TU-1.1
Reduce cigarette smoking by adults aged 18 years and older
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Outcome Objectives
1.1
By 2016, reduce by 10% the rate of overweight and obese adults in Columbia County which
should in turn, reduce the rates of diabetes, coronary heart disease, some cancers and some
joint problems. (Baseline data: rate of 57.5 in 2008-2009, NYS DOH age adjusted statistics.)
1.2
By 2016, reduce by 10% the liquor store rate of 24 liquor stores per 100,000 people in the
county. (Baseline data: NYS DOH, 2011 Columbia, NY, Liquor Store Density)
1.3
By 2016, reduce by 10% the physical inactivity rate of adults aged 20 and over, reporting no
leisure time physical activity. (Baseline: Obesity Stats for Columbia County, NYS Health Dept.
2006-2008)
1.4
By 2016, reduce by 10% the number of adults who do not eat 5 or more servings of fruits and
vegetables per day. (Baseline: Obesity stats for Columbia County, NYS Health Dept 2006-2008)
2.1
By 2016, reduce by 15% the number of children in grade 3 who have dental caries. (Baseline:
Oral Health Indicators for Columbia County, NYS Health Dept, 2002-2004)
2.2
By 2016, triple the number of public water systems providing adequate fluoride concentration
to be considered optimal for the prevention of dental caries. (Baseline: CDC Oral Health Data
Systems, February 2008.)
3.1
By 2016, increase by 15% the number of adult males who visit a primary care physician for
annual routine health screenings. (Baseline: 59.4%, Expanded BRFSS, July 2008-June 2009)
3.2
By 2016, increase by 10% the number of adult females who visit a primary health care physician
for annual routine health screenings. (Baseline: 78.6%, Expanded BRFSS, July 2008-June 2009)
4.1
By 2013, reduce by 12% the cigarette smoking in adults. (Baseline: 24 %, Columbia County
Indicators for Tracking Public Health Priority Areas, Prevention Agenda toward the Healthiest
State)
4.2
By 2016, reduce the proportion of children, aged 3-11, by 10% who were exposed to
secondhand smoke. (Baseline: 52.2% of children aged 3-11, Healthy People, 2020)
Impact Objectives
1.1
By 2016, reduce to 21.6% the rate of excessive drinking, which includes binge plus heavy
drinking. (2011 County Health Rankings, University of Wisconsin, Population Health Institute.)
1.2
By 2016, reduce to rate of 20% the adults in Columbia County that will report being obese.
(Baseline: 22.9%, BRFSS, 2006)
1.3
By 2016, increase by 10% the activity rate of adults aged 20 and over who report participating in
leisure time physical activity in the last 30 days. (Baseline: Obesity Stats for Columbia County,
NYS Health Dept. 2006-2008)
1.4
By 2016, increase the percentage of adult New Yorkers who consume fruits and vegetables five
or more times per day to at least 34.0%. (Baseline: 26.0%, BRFSS, 2005)
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COLUMBIA COUNTY MAPP PROJECT
2.1
By 2016, reduce to 55% the rate of children in grade 3 with dental caries. (Baseline: Oral Health
Indicators for Columbia County, NYS Health Dept, 2002-2004)
2.2
By 2016, increase the number of public water systems to 6 that have adequate fluoride
concentration to be considered optimal for the prevention of dental caries. (Baseline: CDC Oral
Health Data Systems, February 2008.)
3.1
By 2016, increase to 68% the number of adult males who visit a primary care physician for
annual routine health screenings. (Baseline: 59.4%, Expanded BRFSS, July 2008-June 2009)
3.2
By 2016, increase to 86% the number of adult females who visit a primary health care physician
for annual routine health screenings. (Baseline: 78.6%, Expanded BRFSS, July 2008-June 2009)
4.1
By 2013, the percent of adults who smoke will be no more than 12%. (Baseline: 24 %, Columbia
County Indicators for Tracking Public Health Priority Areas, Prevention Agenda toward the
Healthiest State)
4.2
By 2016, decrease to 47% children aged 3-11 exposed to secondhand smoke. (Baseline: 52.2%
of children aged 3-11, Healthy People, 2020)
Strategies for Impact Objectives 1.1 – 1.4
Implement a comprehensive selection of programs for all Columbia County residents to educate them
about chronic disease prevention and management. Research best practices to identify appropriate
curriculum for training public health educators to include but not be limited to nutrition education and
basic cooking programs promoting low calorie, low fat, low sodium and low cost meal preparation,
teaching label reading and encouraging greater consumption of fruits and vegetables and whole grains.
Support policy change that limits/regulates alcohol outlet density to decrease excessive alcohol
consumption and related harms.
Implement the Healthy Restaurant Program to increase the availability of low fat, low sodium, nutrient
dense and low cost menu options for the general public.
Propose possible policy changes to decision makers: for example, sweetened beverage tax or
mandatory calorie posting for menu items at restaurants and fast food places in Columbia County.
Provide more local support for Farmer’s Market programs and community gardens.
Establish various theme-oriented campaigns such as No Sugar Sweetened Beverages, No Junk Food
Campaign and Family Meals Campaign.
Establish nutrition education programs such as Healthy Heart, Five-A-Day, Low Sodium and Low Fat
Cooking, Label Reading, Diabetes Management, Exercise Programs for Different Ages and Stages, and
Planning Meals on a Budget.
Create or enhance access to places in community for physical activity combined with informational
outreach activities. Embrace “Complete Streets” in Columbia County.
Utilize point-of-decision prompts throughout the county to encourage use of the stairs.
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COLUMBIA COUNTY MAPP PROJECT
Advocate for changes in food stamp policies to put restrictions on what food stamps can be used on.
Also support education at food pantries to help participants learn how to use the items they obtain
there.
Working with town and county government, develop a comprehensive plan for “prescription trails” and
recreation areas with safe and easy access for residents of all abilities and physical capabilities
throughout the county.
Strategies for Impact Objectives 2.1 – 2.2
Increase access to dental health services, in particular those who will receive Medicaid.
Promote and support community water fluoridation to reduce tooth decay, especially among children.
Promote and support school-based and school-linked dental sealant delivery programs to prevent or
reduce tooth decay among children.
Promote educational programs that focus on early education for dental care such as, “Brush from the
Start” and campaigns on proper bottle use in the younger months.
Strategies for Impact Objectives 3.1 – 3.2
Research best practices for comprehensive worksite wellness programs and utilize these to implement
worksite wellness programs focused on healthy lifestyles and chronic disease prevention/management.
Partner with health insurance providers serving Columbia County residents to maximize health benefits
in order to live a healthy lifestyle.
Strategies for Impact Objectives 4.1-4.2
Support policy change that reduces exposure to second hand smoke, makes tobacco products less
accessible and less visible, and makes tobacco use more expensive, less convenient and less socially
acceptable. This includes increasing the number of smoke-free parks, playgrounds, recreation areas and
other public spaces, and increasing the availability of smoke-free, affordable multi-unit housing.
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COLUMBIA COUNTY MAPP PROJECT
Mental Health and Substance Abuse
Strategic Issue
How will the Columbia County Public Health System ensure that all individuals are appropriately
screened, referred and have access to mental health and substance abuse services and programs?
Goals
1. Increase use of screening tools by physical healthcare professionals to identify cross system
treatment needs related to mental health and/or substance use/abuse (including tobacco and
prescription medications.)
2. Increase referrals and access to age appropriate and culturally sensitive mental health and
substance abuse services.
3. Increase awareness of behavioral health as an important component of overall wellness and
safety.
4. Reduce the stigma associated with mental illness and substance abuse disorders to enable
people to access needed services.
Relationship to Columbia County Vision
Access to health care and all needed human services
Protects and promotes the health of all ages
Support mental well being
Description of the Issue
Mental health is a state of successful performance of mental function, resulting in productive activities,
fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges.
Mental health is essential to personal well-being, family and interpersonal relationships, and the ability
to contribute to the community or society. Good mental health is important as mental disorders are
among the most common causes of disability.
Mental health and substance abuse are interlinked with physical health status and behaviors. Research
has shown that many risky behaviors such as tobacco, alcohol and substance abuse, problem gambling
and risky sexual activity as well as eating disorders, suicide, school failure, poor overall health,
incarceration and homelessness often occur within the context of mental health concerns.
Tobacco use is higher among the mental health and substance abuse populations, contributes to shorter
life expectancy, and interferes with the effectiveness of some psychiatric medications.
One of these risky behaviors (mentioned above) excessive drinking, is at a dangerous level in Columbia
County. In the 2011 Health Rankings, compiled by the University of Wisconsin Population Health
Institute, Columbia County is at 24% for binge/excessive drinking compared to the National Benchmark
of 8%.
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Excessive drinking is a risk factor for a number of adverse health outcomes such as alcohol poisoning,
hypertension, acute myocardial infarction, sexually transmitted infections, unintended pregnancy, fetal
alcohol syndrome, sudden infant death syndrome, suicide, interpersonal violence, and motor vehicle
crashes.
There is recognition of another increasingly growing public health issue which is that persons with
mental illness and substance abuse disorders are extremely dependent on tobacco. If people with
mental illness and substance abuse issues are to become truly well, smoking cessation must become a
part of their treatment plan.
There is a great need for more comprehensive screenings to be done by an individual’s primary
healthcare provider. Screenings need to be included for alcohol use, tobacco use, prescription drug use,
and mental health status, as well as the standard ones we have embraced in the last 20 plus years. This
screening needs to be a part of a patient’s (across the lifespan ) annual physical recognizing that poor
mental health and substance abuse issues can affect anyone at almost any age.
There are 6 Mental Health Providers for the county which gives us a Mental Health Provider ratio of
10,237:1 (That means the number of people to each mental health provider ratio.) Data on mental
health providers comes from the Health Resources and Services Administration’s (HRSA) Area Resource
File (ARF).
In 2007, adults in 37 states and territories were surveyed about their attitudes toward mental illness,
using the 2007 Behavioral Risk Factor Surveillance System (BRFSS) Mental Illness and Stigma module.
This study found that:
78% of adults with mental health symptoms and 89% of adults without such symptoms agreed
that treatment can help persons with mental illness lead normal lives.
57% of adults without mental health symptoms believed that people are caring and sympathetic
to persons with mental illness.
Only 25% of adults with mental health symptoms believed that people are caring and
sympathetic to persons with mental illness.
This information helps to substantiate that the stigma associated with people who have mental health
issues is real and needs to be addressed.
Following are the objectives and strategies that have a direct link to the HP (Healthy People) 2020
objectives related to mental health and substance abuse.
SA - 1 Reduce the proportion of adolescents who report that they rode, during the previous 30 days,
with a driver who had been drinking alcohol
SA-10 Increase the number of Level I and Level II trauma centers and primary care settings that
implement evidence-based alcohol Screening and Brief Intervention (SBI)
SA –15 Reduce the proportion of adults who drank excessively in the previous 30 days
SA - 16 Reduce average annual alcohol consumption
SA - 17 Decrease the rate of alcohol-impaired driving (.08+ blood alcohol content [BAC]) fatalities
MHMD-1 Reduce the suicide rate
MHMD-11 Increase depression screening by primary care providers
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COLUMBIA COUNTY MAPP PROJECT
MHMD-10 Increase the proportion of persons with co-occurring substance abuse and mental disorders
who receive treatment for both disorders
TU-10.4
Increase tobacco cessation counseling in substance abuse care settings
Outcome Objectives
1.1
By 2016, fully integrate mental health promotion and mental illness prevention and treatment
with other disease prevention programs. (No current baseline data.)
2.1
By 2016, reduce rate by 10% of mentally unhealthy days reported in last 30 days among adults
aged 18 years and older. (Baseline data: > 3.7 in 2009, BRFSS)
3.1
By 2016, reduce the number of people who report having a negative perception of behavioral
and/or substance use disorders. (No current baseline data – to be determined)
4.1
By 2016, reduce the percentage of adults reporting binge drinking (5+ drinks in a row) during the
past month by 10%. (Baseline: 24% Columbia County Health Rankings, 2011 University of
Wisconsin Population Health Institute) (BRFSS 2010 for NYS 13.9 – 15.8 %)
5.1
By 2016, reduce the rate smoking rates in the mental health and substance abuse populations in
Columbia County. (No current baseline data)
Impact Objectives
1.1
By 2013, establish baseline data to measure the frequency of use of cross system screening tools
by healthcare professionals by conducting a county wide survey.
2.1
By 2016, the rate of mentally unhealthy days reported in the last 30 days among adults aged 18
years and older will be reduced to > 3.3.
3.1
By 2013 establish baseline data to measure the number of people having a negative perception
of behavioral and/or substance abuse disorders by conducting several focus groups and surveys.
4.1
By 2016, reduce the percentage of adults reporting binge drinking (5+ drinks in a row) during the
past month to 21.6%.
5.1
By 2014, establish baseline data to measure the smoking rates in the mental health and
substance abuse populations in Columbia County.
Strategies for Outcome Objective 1.1
Develop and maintain a referral network for physical healthcare professionals.
Work with physical healthcare professionals in developing cross system referral processes with follow
through to improve access to mental health and substance abuse services.
Work with physical healthcare professionals in implementing cross system screening tools which identify
treatment needs outside their scope of practice.
Work with physicians to develop appropriate pain management medication protocols in an effort to
avoid addiction.
Work with existing networks such as the Columbia County Community Services Board and its
subcommittees, Mental Hygiene Network and Healthcare Consortium to coordinate mental health,
physical health and substance abuse treatment services and programs, as well as the newly formed
Columbia County Public Health Leadership Team.
Develop a resource “pocket card” for professionals to distribute to patients/clientele.
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Strategies for Outcome Objectives 2.1 and 3.1
Work with the Rip Van Winkle Tobacco Free Action Initiatives to eliminate/reduce smoking in indoor and
outdoor living spaces.
Create mass media campaign to raise awareness, inform and educate the general population about the
broad range of consequences related to untreated behavioral healthcare issues with an emphasis on
prevention and treatment. These campaigns need to target school, community college and worksite
populations.
Create easily accessible prevention programs which target the physical health issues common to the
mental health and substance abuse populations (i.e. use of tobacco products and related respiratory
diseases, diabetes, obesity, etc.) This would include increasing access to tobacco cessation groups for
those with mental illness and substance abuse.
Strategies for Outcome Objective 4.1
Create mass media campaign to raise awareness, inform, and educate the general population about the
broad range of consequences related to untreated behavioral healthcare issues with an emphasis on
prevention and treatment.
Work with the Columbia County Community Services Board and its subcommittees to improve access to
mental health and substance abuse services by identifying and removing actual and perceived barriers.
Regulate the alcohol outlet density in Columbia County by maintaining or, preferably decreasing the
number of existing liquor stores. (There is an estimate of 20 liquor stores in Columbia County.)
Support local law enforcement and the courts to enforce underage drinking laws, motor vehicle
DWI/DUI laws and boating BWI/BUI laws.
Support local law enforcement to hold owners and servers of retail alcohol establishments liable where
a customer consumed alcoholic beverages and subsequently harmed another human being or their
property.
Strategies for Outcome Objective 5.1
Actively address nicotine dependence in the clinical setting.
Make cessation resources, including those provided by peers, available to mental health and substance
abuse clients.
Publicize availability of services from NYS Smokers’ Quitline and stop smoking benefits provided by
Medicaid and Family Health Plus.
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Community Partnerships
Strategic Issue: How can the Columbia County Public Health System improve the delivery of all essential
health services through collaborations and partnerships to maximize services and programs?
Goals
1. Establish and nurture community partnerships and strategic alliances to assure a comprehensive
approach to improving health in the community and to maximize public health improvement
activities.
2. Educate stakeholders, decision-makers, and employers as to the role they need to play in
helping Columbia County residents live healthy lives.
Relationship to Columbia County Vision
A healthy community is clean, safe and has ready access to health care and all needed human
services.
Community awareness, diversity and development are strengthened through knowledgeable,
engaged and nurturing involvement by many citizens and leaders…..
A healthy community has a strong Public Health System……..
Description of the Issue
Mobilizing community partnerships to identify and solve health problems was the weakest area
measured in the Local Public Health System Performance Assessment which is a component of the
NPHPSP (National Public Health Performance Standards Program). This was one of the 4 assessments
conducted during the MAPP Assessment in Phase III. In particular, Columbia County fell short on:
1. Having a community health improvement committee and
2. Reviewing community partnerships and strategic alliances and
3. Using broad-based communication to build awareness of public health
According to Healthy People 2020, educational and community based programs play a key role in:
Preventing disease and injury
Improving health
Enhancing quality of life
It has been determined that educational and community-based programs and strategies played an
important role in reaching the Healthy People 2010 objectives. Over this next decade they will continue
to contribute to the improvement of health outcomes in the United States. Education and communitybased programs and strategies are designed to reach people outside of traditional health care settings,
which may include: schools; worksites; health care facilities; and communities-at-large. Each setting
provides opportunities to reach people using existing social structures. This maximizes impact and
reduces the time and resources necessary for program development.
Therefore, we must embrace the partnership concept at a deeper level in Columbia County, realizing
that no one agency or group alone can create a healthy community. Local government, businesses,
health care, education, community and faith-based organizations are all essential partners in the effort
to improve the health and quality of life for all Columbia County residents.
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One specific model of community partnership is worksite wellness programs. According to the National
Prevention Strategy published in June of 2011, businesses are one of several partners to support
prevention in the community. For example, a small business that supports evidence-based workplace
wellness efforts and safety policies and programs can reduce health risks and improve the quality of life
for millions of workers in the United States. Improving the health of our nation’s workforce is good for
both employees and employers—it improves employee productivity, reduces health care expenditures,
and encourages economic growth.
Find below the objectives and strategies that have a direct link to the HP (Healthy People) 2020
objectives:
ECBP – 8 Increase the percentage of worksites that offer an employee health promotion program to
their employees.
ECBP – 9 Increase the proportion of employees who participate in employee-sponsored health
promotion programs.
Also, from the Model Standards of the National Public Health Performance Standards Program,
(NPHPSP) it is stated that to accomplish a healthy and productive level of community partnerships, the
Local Public Health System (LPHS):
Establishes community partnerships and strategic alliances to assure a comprehensive approach
to improving health in the community.
Assures the establishment of a broad-based community health improvement committee.
Assesses the effectiveness of community partnerships and strategic alliances in improving
community health.
Outcome Objectives
1.1 By April of 2012, the Public Health Leadership Team will convene for the first time and adopt the
mission to maximize public health improvement activities in Columbia County. This group will also
review community partnerships and strategic alliances and use broad-based communication to
build awareness of public health. (local goal)
2.1 By 2016, increase by 10% the percentage of worksites that offer an employee health promotion
program to their employees. (Healthy People 2020, establish baseline data)
2.2 By 2016, increase by 10% the proportion of employees who participate in employee-sponsored
health promotion programs. (Healthy People 2020, establish baseline data)
Impact Objectives
1.1 By 2016, the Public Health Leadership Team will be a recognized entity with authority to make
decisions and to affect policy to create a healthy and vibrant community. (local goal)
2.1 By 2016, there will be a 10% increase in the percentage of worksites that offer an employee
health promotion program to their employees. (Healthy People 2020, no specific data)
2.2 By 2016, there will be a 10% increase in the proportion of employees who participate in employee
sponsored health promotion programs. (Healthy People 2020, no specific data)
Strategies for Outcome Objective 1.1
Establish a broad-based Columbia County Public Health Leadership Team that will meet regularly to
oversee the coordination and delivery of necessary health care services to achieve the overall goal of
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community health improvement by monitoring and evaluating progress toward prioritized goals. This
group will meet to get behind issues, educate the community and stakeholders, bring a “strong voice”
when needed, and to assist with the development and implementation of a County dashboard.*
*A dashboard is a web site that organizes information so that it is easy to read and interpret. It
also provides up-to-date status information on critical issues.
Educate and inform the county Board of Supervisors to empower them to take some financial
responsibility for the health of Columbia County residents.
Train appropriate staff in the curriculum, “Building Buy-In: How to Mobilize, Inspire and Sustain
Community Projects” to prepare them to work with decision makers and stakeholders.
Conduct a comprehensive assessment of health-related programs being held in the county. Identify if
they are mandated, the strengths and the weaknesses of the programs, and how they are governed.
Organize and hold an annual “Interagency Awareness Day” to promote networking and collaboration
among community agencies and programs.
On a quarterly basis, organize and hold community forums/roundtables around a common theme to
discuss current issues and events.
Publish an electronic directory of Public Health Programs and Services that would be available to the
General Public and update it annually.
Strategies for Outcomes 2.1 and 2.2
Conduct a survey of worksites to determine the existence and number of employee wellness programs
in Columbia County.
Using the evidence based information from The Community Guide, develop recommendations for
worksite-based interventions to improve workers’ health. The Task Force from The Community Guide
recommends the use of assessments of health risks with feedback when combined with health
education programs to improve the following outcomes among workers:
Tobacco use (strong evidence of effectiveness)
Excessive alcohol use (sufficient evidence of effectiveness)
Seat belt use (sufficient evidence of effectiveness)
Dietary fat intake (strong evidence of effectiveness)
Blood pressure (strong evidence of effectiveness)
Cholesterol (strong evidence of effectiveness)
Number of days lost from work due to illness or disability (strong evidence of effectiveness)
Summary health risk estimates (sufficient evidence of effectiveness)
Assemble a group of speakers and topics and promote their availability to the worksites.
Conduct worksite wellness programs throughout the county on a by-request system.
Consider being trained and implementing the health coach/wellness coach model at worksites.
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COLUMBIA COUNTY MAPP PROJECT
Access to Quality Primary Care
Strategic Issue
How can the Columbia County Public Health Care System assure access to affordable primary care for its
residents?
Goals
1. Columbia County residents will have access to affordable primary care services, particularly the
under-insured and uninsured.
2. Improve the health literacy levels of Columbia County residents, empowering them to take
charge of their health and to have a health care home.
3. Improve access to early prenatal care to improve birth outcomes and reduce the infant
mortality rate.
4. Increase the percentage of children screened for lead during the first two years of their life.
Relationship to Columbia County Vision
A healthy community is clean, safe and has ready access to health care and all needed human
services.
A healthy community has a strong Public Health System that includes:”…..and which protects
and promotes the health of residents of all ages…”
Description of the Issue
Access to quality care is important to eliminate health disparities and increase the quality and years of
healthy life for all New Yorkers. Patients who are women, older, members of racial and ethnic
minorities, poorer, less educated, or uninsured are less likely to receive needed care, primarily because
they lack access to care. These disparities are growing.
Limited access to health care impacts people's ability to reach their full potential, negatively affecting
their quality of life. Barriers to services include: lack of availability; high cost; lack of insurance coverage.
These barriers to accessing health services lead to: unmet health needs; delays in receiving appropriate
care; inability to get preventive services; hospitalizations that could have been prevented.
Health insurance can make a difference for a lifetime. Health insurance affects how individuals receive
necessary medical care, where they go for care, and their overall health
In the report Healthy People 2010, the U.S. Department of Health and Human Services included
improved consumer health literacy as an important component of health communication, medical
product safety, and oral health. In Healthy People 2020 health literacy is once again identified as an
important health communication strategy, as well as information technology (IT), to improve population
health outcomes and health care quality, and to achieve health equity.
During the coming decade, the speed, scope, and scale of adoption of health IT will only increase. Social
media and emerging technologies promise to blur the line between expert and peer health information.
Monitoring and assessing the impact of these new media, including mobile health, on public health will
be challenging.
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Although New York has made great strides in improving birth outcomes, key peri-natal indicators have
remained stagnant or have worsened. Some of the most significant factors that influence birth
outcomes occur before pregnancy, such as nutritional status and other health behaviors. Taking a life
course approach which involves encouraging healthy behaviors from early childhood through adulthood
may be key in improving birth outcomes.
Infant mortality and childhood asthma hospitalization rates have been decreasing in New York State
over the last decade, with an infant mortality rate lower than the Healthy People 2020 goals. Over this
same time period, NYS has seen a slight increase in the percent of low birth weight infants, while the
percent of women receiving early prenatal care has seen little or no improvement. However the percent
of women receiving early prenatal care has declined each year from 71.3% in 2005 to 66.5% in 2008.
These rates also do not meet the Healthy People 2020 goals. In addition, the incidence of elevated lead
levels in blood among children is still higher than Healthy People 2020 goals in some counties.
The cost of poor maternal, infant and child health is significant. According to one study, the total societal
economic burden associated with preterm birth is at least $26.2 billion, an average of $51, 600 for each
preterm infant. In another study, the cost of neonatal care for infants of mothers who smoked is
estimated to be $367 million nationwide, with New York State’s cost estimated to be about $23 million.
Find below the objectives and strategies that have a direct link to the HP (healthy People) 2020
objectives related to Quality Primary Care:
AHS – 1
Increase the proportion of persons with health insurance
HC/HIT -1
Improve the health literacy of the population
HC/HIT – 2.1 Increase the proportion of persons who report that their health care provider always
listened carefully to them
HC/HIT – 2.2 Increase the proportion of persons who report that their health care provider always
explained things so they could understand them.
HC/HIT – 3
Increase the proportion of persons who report that their health care provider always
involved them in decisions about their health care as much as they wanted
MICH – 10
Increase the proportion of pregnant women who receive early and adequate prenatal
care.
MICH - 11
Increase abstinence from alcohol, cigarettes, and illicit drugs among pregnant women.
MICH – 32
Increase appropriate newborn blood-spot screening and follow-up testing.
Outcome Objectives
1.1 By 2013, increase by 11% the percentage of Columbia County residents with health care coverage.
(Baseline 89.9%, BRFSS, 2009)
2.1 By 2016, improve the health literacy of Columbia County residents by 50%. (no current baseline
data – to be developed)
3.1 By 2013, increase by 13% the number of women in Columbia County who receive prenatal care in
the first trimester. (Baseline: 77.7%, NYS DOH Vital Statistics 2006-2008)
3.2 By 2013, reduce the percent of Columbia County births that are low birth weight (<2500 grams) by
3%. (Baseline: 7.8%, NYS DOH Vital Statistics 2006-2008)
3.3 By 2013, reduce Columbia County’s rate of infant deaths to no more than 4.5 deaths per 1000 live
births. (Baseline: 7.8, NYS DOH Vital Statistics 2006-2008)
4.1 By 2013, increase the percentage of Columbia County children who had at least one lead screening
test by 36 months of age by 20%. (Baseline: 76.3% NYS Childhood Lead Program data, 2004 birth
cohort)
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Impact Objectives
1.1 By 2013, 100% of Columbia County residents will have health care coverage. (Baseline: NYS DOH
Prevention Agenda toward the Healthiest State, 2013)
2.1 By 2013, develop the components to measure health literacy and formulate a survey instrument to
be given throughout the county. (this will give the baseline data)
2.2 By 2016, the health literacy of Columbia County residents will have increased by 50%. (Baseline
data: county survey given in 2013)
3.1 By 2013, 90% of the women in Columbia County will have received prenatal care in the first
trimester of their pregnancy.(Baseline: NYS DOH Prevention Agenda toward the Healthiest State,
2013)
3.2 By 2013, reduce the percent of Columbia County births that are low birth weight (<2500 grams) to
no more than 5%. (Baseline: NYS DOH Prevention Agenda toward the Healthiest State, 2013)
3.3 By 2013, reduce Columbia County’s rate of infant deaths to no more than 4.5 deaths per 1,000 live
births. (Baseline: NYS DOH Prevention Agenda toward the Healthiest State, 2013)
4.1 By 2013, increase the percentage of Columbia County children who had at least one lead screening
by 36 months of age to at least 96%. (Baseline: NYS DOH Prevention Agenda toward the Healthiest
State, 2013)
Strategies for Outcome Objective 1.1
Promote existing healthcare plans and programs for limited-income, under-insured and uninsured
Columbia County residents.
Explore the option of establishing a Healthy Families Resource Center, with several satellite offices
around the county, to conduct health screenings, education and counseling programs, and mental
health services OR explore the option of having a mobile health education and care unit to cycle around
the county to meet the needs of residents in the outer rural areas.
Provide residents with a consistently updated directory of primary care and dental offices available in
Columbia County who are receiving new patients and patients on Medicaid.
Utilize the Public Health System Leadership Team to oversee progress in assurance of access to primary
and dental care in the county.
Explore transportation issues for target populations and develop possible solutions.
Strategies for Objective 2.1
Assist Columbia County residents in understanding the importance of having a primary health care
provider in order to reduce overall health care costs and to obtain optimal personal health.
Strategies for Objectives 3.1-3.3
Develop a “Pregnancy Coach Program” and connect women between the ages of 18-24 with a prenatal
coach during the first three months of pregnancy. Locate at school health offices, at CGCC, at DSS, WIC,
and Women’s Health Center in Hudson.
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COLUMBIA COUNTY MAPP PROJECT
Workforce Development in the Healthcare System
Strategic Issue
How can the Columbia County Public Health System strengthen and support the capacity of the Public
Health Workforce?
Goals
1. Organizations within the Columbia County Public Health System must develop and maintain
public health workforce standards for workers who deliver and/or contribute to the Essential
Public Health Services.
2. Incorporate into personnel services the core and specific competencies that are needed to
provide the Essential Public Health Services.
Relationship to Columbia County Vision
A healthy community is clean, safe and has ready access to health care and all needed human
services.
A healthy community has a strong Public Health System that includes: ………effective response to
challenges, assessments and accountability, and which protects and promotes the health of
residents of all ages……..
Description of the Issue
From Healthy People 2020, we must ensure that Federal, State, Tribal and local health agencies have the
necessary infrastructure to effectively provide essential public health services. Public health
infrastructure includes three key components that enable a public health organization to deliver public
health services. These components are:
1. A capable and qualified workforce
2. Up-to-date data and information systems
3. Public health agencies capable of assessing and responding to public health needs
These components are necessary to fulfill the following 10 Essential Public Health Services:
1. Monitor health status to identify and solve community health problems.
2. Diagnose and investigate health problems and health hazards in the community.
3. Inform, educate, and empower people about health issues.
4. Mobilize community partnerships and action to identify and solve health problems.
5. Develop policies and plans that support individual and community health efforts.
6. Enforce laws and regulations that protect health and ensure safety.
7. Link people to needed personal health services and assure the provision of health care when
otherwise unavailable.
8. Ensure competent public and personal health care workforces.
9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
10. Research for new insights and innovative solutions to health problems.
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According to the New York area Health Education Center System, New York suffers from a shortage of
health care workers (doctors, nurses, therapists, medical technologists, pharmacists and other
professionals) especially in inner city neighborhoods and rural communities. Diversity is also an issue.
The people who provide the care don’t look like the people they treat. Diversity is important because it
is opens the door to communication between the provider and the patient.
As a result of the Local Public Health System Performance Standards assessment conducted as a part of
the MAPP process, improvements were identified as needed in the assurance of a competent public and
personal health care workforce.
Find below the objectives and strategies that have a direct link to the HP (Healthy People) 2020
objectives:
PHI – 1.4 Increase the proportion of local public health agencies that incorporate core competencies
for Public Health Professionals into job descriptions and performance evaluations.
PHI – 17 Increase the proportion of local public health agencies that are accredited.
Outcome Objectives
1.1
2.1
By 2016, 75% of all workers in the Public Health System will have been trained in the 10
Essential Public Health Services.
By 2016, increase by 10% the number of local Public Health Agencies Incorporating Core
Competencies for Public Health Professionals into job descriptions.
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APPENDIX D:
The TOP FIVE of the Ranked and Combined Quadrant 2
(High Importance/Less Difficult):
Goals and Priorities Responses
With Scores Over 35
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ACTION CYCLE
Ranked and Combined Quadrant 2 (High Importance/Less Difficult):
Goals and Priorities Responses
With Scores Over 35
February 28, 2012
Note: This format captures basic information common to all identified priorities. This will provide a
uniform foundation (Why this is important; who is doing what; who is the target population) for
continuing the process and facilitate setting priorities.
1. Work with existing networks such as the Columbia County Community Services Board and its
subcommittees, Mental Hygiene Network and Healthcare Consortium, to coordinate mental
health, physical health and substance abuse treatment services and programs, and to improve
access by identifying and removing actual and perceived barriers as well as the newly formed
Columbia County Public Health Leadership Team . SCORE: 47
Importance: There is no one working to coordinate issues now, and the power of all the services
can be exponentially improved with small efforts of coordination.
Interagency coordination yields more efficient (less costly) and more effective (better
outcomes). There is significant evidence to support that well-designed and managed approaches
produce both human and economic benefits and improved organization and system
performance.
Working collaboratively saves tax money as well as is in the best interest of the patient.
Networking and clear communication is the backbone of any effective system of care. By
developing a cross system network we will strengthen all partners/stakeholders and present a
clear and comprehensive public health strategic plan which is inclusive of all populations
represented in the county.
Organizational auspice/lead agency: Possibly the Public Health Leadership Team. This will
require a mechanism for participation by all stakeholders. The element of “authority” is
significant. This is where a Public Health leadership Team or Human Services Cabinet consisting
of DSS, MH, DOH, and OFA vested with a clear charge and authority is necessary. Some level of
staff support is critical to success.
Twin County
Public Health Leadership Team would be lead. Membership would be representative of existing
networks
Other Agencies involved: Columbia County Mental Health, Twin County Recovery Services,
Columbia County Health Care Consortium, and Columbia County Health Department. OFA, CMH,
REACH, Child Advocacy Center, DSS, CGMHA, Columbia County Human Services
CSB, Subcommittees and Mental Hygiene Network include participation by mental health,
substance abuse and developmental disabilities service provider agencies and interested
community members,
The Mental Hygiene Network also includes involvement of the local hospital
Current activities: Everyone is doing excellent work already – but there is opportunity to
improve the effectiveness (reduce waste) and capitalize on what is ALREADY being done with
some simple coordination and communication. Nominally, there is much coordination occurring
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COLUMBIA COUNTY MAPP PROJECT
under the aegis of various planning requirements. How much of that is anchored in outcome
measures that are actually used is unknown.
Treatment services
Currently the CSB, Subcommittees and Mental Hygiene Network meet monthly, with a summer
hiatus. The CSB and subcommittees mission is to identify community based service needs for
the three disability populations which include physical health, and recovery supports including
housing, vocational, recreation and family support. Each county in NYS generates an annual
Local Government Plan with identified needs, local planning priorities with strategies and
recommendations
The Mental Hygiene Network keeps track of local activities and service providers response to
the planning priorities listed in the Local Government Plan
Target population: All health related programs and all residents. Children, adults, families
affected by substance abuse and mental illness. Particular attention might be needed for the
uninsured since coverage has a significant effect on access to and type of service received.
10-25 age group
children and adults with mental health, substance abuse and/or developmental disabilities
2. Promote and support school-based and school-linked dental sealant delivery programs to
prevent or reduce tooth decay among children; promote educational programs focusing on
early education for dental care such as “Brush from the Start,” and campaigns on proper
bottle use; and increase lead screening. All are early childhood focused. SCORE: 44
Importance: Preventing tooth decay not only will help eradicate future actual dental and health
issues (thereby reducing future costs), but also improves self esteem and appearance…which
can be a factor in employment. Dental health is directly linked to overall health. Preventive
dental care is an important component of staying healthy, reducing health care costs, and
improved quality of life.
There are 84 dentists in practice within a 30 mile radius of Hudson. Children with no insurance
are not provided routine dental care. Funds are needed to ensure parents and children are
educated about dental care.
Early childhood Prevention programs provide a healthy foundation from which to build. Early
learning sets up a habit of care which lasts an entire life.
Early identification reduces harm, raises awareness and identifies treatment or corrective
strategies
Organizational auspice/lead agency: Columbia Memorial Hospital Dental Services Program
Other agencies involved: Schools, CMH dental services program, Columbia County Department
of Health, dentists. NYS Dental Society, area dentists, pediatricians
Current activities: Hospital program, dental van visits and Mobile Dental Program for all schools
in Columbia County (some programs also in Greene.) Funded by NYS Dental Society, NYSDOH,
private Funding and supported by local dentists.
Target population: children in grades 3-4; early childhood education of parents
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COLUMBIA COUNTY MAPP PROJECT
3. Research best practices for comprehensive worksite wellness programs and utilize these to
implement worksite wellness programs focused on healthy lifestyles and chronic disease
prevention/management; using the evidence based information from The Community Guide,
develop recommendations for worksite-based interventions to improve workers’ health. The
Task Force from The Community Guide recommends the use of assessments of health risks
with feedback when combined with health education programs to produce identified
outcome measures among workers. Conduct worksite wellness programs throughout the
county on a by-request system. All are worksite wellness focused. SCORE: 40
Importance: Worksite programs create a captive audience and therefore an effective
dissemination of information. It is a cost effective way of reaching a large number of
residents…because not only will the actual employees be effective, but their families and
possibly their wider circle of influence.
The workplace is an effective venue for incentivizing wellness. Participation by employees
reduces health insurance costs to the employer, yields improved productivity and quality of
work, and enhances overall well-being for employees.
There is a need for employers to offer worksite wellness programs and provide basic education
to decrease costs related to insurance. Offering prevention programs at the workplace has a
significant return on investment. Just a basic assessment can predict basic cost savings.
This would be a natural consequence if the Columbia County Public Health Leadership Team was
successful on #4 below.
A healthy workforce increases productivity through improved attendance, higher energy levels,
and better self esteem and reduces business expenses by having a stable and consistent
workforce.
Organizational auspice/lead agency: Employer-specific with support from CCDOH. Columbia
County as a significant employer should play a visible role so CC Human Resources is a major
stockholder.
Certified Worksite Wellness Coordinators Columbia County Department of Health/Columbia
Memorial Hospital/Chamber of Commerce.
Other agencies Involved: Membership of the Public Health Leadership Team
Current activities: This is about education. The County has now moved to almost 100% to MVP.
MVP offerings a Wellness Rewards program with monetary incentives that could be promoted
more strongly to the county employees. Also, the county has a stronger vested interest in
increasing wellness as they continue to consider the effectiveness of a self insured program.
Target population: Columbia County and Columbia Memorial Hospital employees, adult
workforce
4. Educate and inform the county Board of Supervisors to empower them to take some shared
responsibility for the health of Columbia County residents. SCORE: 40
Importance: For education – in hopes that 1) they will share with their communities, and help
empower and support coordination efforts 2) They will understand the long and short term
impacts of cutting, or creating, funding 3) To offer enhanced grant support
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COLUMBIA COUNTY MAPP PROJECT
The health of county employees is directly related to performance and health insurance costs to
the tax payers. Similarly, the health of county residents is tied to Medicaid costs which have a
significant local share.
Government officials need to be kept apprised of the health of the community they serve and
the impact it has on the taxes. Everyone should take a self assessment to determine risk for
illness.
To accomplish some health strategies the BOS needs to understand the cross system impact
positive and negative of good health. We need the BOS to support health concepts that may
seem unrelated. Education illuminates problems and changes the language used. The BOS has
to get to a point where the achievement of good health is expected not hoped for through some
vague bumper sticker like mentality
Organizational auspice/lead agency: DOH, Public Health Leadership Team
Other agencies involved: DSS if wellness is to be focus for MA population
Current activities: Agencies are providing information to the BOS separately but there is no one
connecting the dots. That is what the Columbia County Public Health Leadership Team would
do.
Target population: Board of Supervisors. Most two year terms on even year cycle (2012, 2014,
etc). Home Committees: Health, Budget & Salary; Finance; Insurance
Local government officials and town government law enforcement agencies, residents
5. Promote existing healthcare plans and programs for limited-income, under-insured and
uninsured Columbia County residents. SCORE: 39
Importance: This is the population most vulnerable to long term health care issues – and
prevention/early detection will save time, money and lives.
A healthy population is a healthy workforce which is an aspect of attracting new employers.
This is of HIGH importance as all community residents should be educated in the insurance
process and consequences as a result of not having insurance.
A major hurdle for the poor in treatment is the cost of co-pays or out of pocket expenses. The
health care industry actually charges the uninsured more money for procedures because they
have no insurance plan curtailing what they can bill. Everyone needs to be covered by some
type of insurance
Organizational auspice/lead agency: CCHCC, DOH, CMH
Other agencies involved: DOH,CMH, Chamber of Commerce, DSS
Current activities: Facilitated enrollment
Target population: Low Income, Under-insured and uninsured residents identified by Social
Services, Health and Mental Health, CMH, the Healthcare Consortium, Office of the Aging
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