Building Healthy Communities Conference At the Intersection of Community Development & Health: Innovative Approaches In this panel, we highlight strategies, initiatives, and programs where there is collaboration between community and health organizations geared toward improving community health. Robert Kahn, Associate Chair, Community Child Health, Cincinnati Children’s Martha Halko, Deputy Director, Cuyahoga County Board of Health  Angela Mingo, Community Relations Director, Nationwide Children’s Hospital  October 23, 2014

Goal To highlight strategies, initiatives, and programs where there is collaboration between community and health organizations geared toward improving community health

Overcoming Obstacles to Health, Robert Wood Johnson Foundation, 2008

Established relationships, communication Attributes Adequate funding Shared vision, goals Skilled leadership Mutual respect Established relationships, communication Innovation Collaboration history Existing models, best practices

Changing the Outcome, Closing the Gap Population health work Asthma and housing Community agency - health care collaborations Beyond collaborations to networked production Moving beyond health care hospital level clinic level

Population Health Initiative Hamilton County: 190,000 children age birth -17yrs Goal and Initiatives Purpose Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations High Level Measures By June 30 2015, Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid 2010 – To be the leader in improving child health… not health care… Board commitment to population child health – sense of the scope of the effort.. Fundamentally requires that we build new relationships – with communities, with families, and with children themselves 90% market share… great market share comes great responsibility

CCHMC

CCHMC has 90+% of all asthma admissions in county Quintile 1: 18 admits among 29,000 kids 0.6 per 1000 Quintile 5: 299 admits among 17,900 kids 16.7 per 1000 Beck (2013)

Who are the critical partners? Pharmacies Cincinnati Public Schools Cincinnati Health Department Community Development Corp Community health workers Legal Aid Society

Cincinnati Asthma Admissions and Neighborhood Asthma Hotspots

Legal Aid Housing Cases Mapped Against Neighborhood Asthma Hotspots

Attacking social determinants directly Community partnerships have allowed to us to begin to understand and further explore the root of community hot spots. This map represents one such hot spot, comprised of 19 buildings each known individually for their deplorable conditions. The commonalities between these buildings was identified through the combined effort of our clinicians and our community partners at the Health Department and Legal Aid Society. It all began with a single family that included 2 children with asthma that was referred to our Medical-Legal Partnership for housing issues that had not been fixed by the building manager. Over the next 18 months, 15 more referrals from our outpatient clinic were made to the Legal Aid Society for similar complaints from 1 of the 19 buildings. 2/3 of families referred included at least one child with asthma. The many referrals that came in allowed for legal advocates to note that each of these 19 buildings was under the same management group that had gone under foreclosure. This pattern recognition sparked community interest, as seen in our local paper, and, more importantly, it allowed for more organized interventions aimed at improving conditions and protecting tenants. Conditions in these buildings were potentially causing worsened symptoms among our patients who had been referred (and at least 8 who had been admitted to the hospital from these buildings within the last 9 months). Though interventions that focused on each individual case continued, collective, community-wide action also was possible, action that may prevent others from being affected by such adverse conditions. TCB purchased 19 buildings,… collaborated with Urban League, Community Developmt Corporation, Children’s Hospital .. in December of 2012, HUD awarded $29.5 million in 2012 Choice Neighborhoods Implementation Grant for Avondale

Avondale and Asthma – Neighborhood approach Engaging Legal Aid: Child-Health Law Partnership 181 total utilizations – 130 ED visits, 51 admissions Beck (2014)

Avondale Beck (2014)

“Heat map” of building code violations Avondale “Heat map” of building code violations Beck & D. Jones (2014)

Avondale CHOICE Buildings to be refurbished by The Community Builders Beck (2014)

Avondale Worked with my wide receiver, running back, defensive line… Beck (2014)

Network of care community health worker Legal Aid schools pharmacy In this descriptive study of the medical neighborhood of children with CCCs, we found that although a considerable amount of collaboration exists among agencies, there are many gaps in this collaboration network, especially between clinical programs and community programs such as nursing agencies and family support services. To quantify collaboration, we used SNA, a method that has, to our knowledge, not been used previously in health Acad Pediatr. Author manuscript; available in PMC 2013 May 1. Published in final edited form as: Acad Pediatr. 2012 May; 12(3): 189–197. doi:  10.1016/j.acap.2012.02.007 PMCID: PMC3354334 NIHMSID: NIHMS360624 Agency Collaboration in the Care of Children with Complex Chronic Conditions Savithri Nageswaran, MD, MPH,1,2 Edward H. Ip, PhD,3,2 Shannon L. Golden, MA,1 T. Michael O’Shea, MD, MPH,1,2 and Douglas Easterling, PhD2 pharmacy CHOICE building case manager Figure. Collaborations between agencies serving children with complex chronic conditions. Acad Ped 2012

Moving beyond health care: Hospital Population Health Initiative Hamilton County: 190,000 children age birth -17yrs Goal and Initiatives Purpose Lead, advocate and collaborate to measurably improve the health of local children and reduce disparities in targeted populations By June 30 2015, Reduce the use of the ED and inpatient services by 20% in children with asthma covered by Medicaid Reduce infant mortality by 15%, 20 infant deaths per year Reduce the occurrence of unintentional pediatric injuries 30% Reverse the trend of increasing childhood obesity in grades K-3 Early mental health promotion and intervention School readiness and Grade 3 reading 2010 – To be the leader in improving child health… not health care… Board commitment to population child health – sense of the scope of the effort.. Fundamentally requires that we build new relationships – with communities, with families, and with children themselves 90% market share… great market share comes great responsibility

Preterm birth in Hamilton County

Exceptional health for every child, together Moving beyond health care: Clinics What A Prepared Clinic Will Detect Exceptional health for every child, together Maslow’s Hierarchy of Needs Potential Collaborations Unemployment; lack of high school degree; higher level job training Achieving potential Esteem & Respect Belonging Safety Basic Human Needs Overwhelmed new parents; lack of parenting role models Domestic violence; mental health issues; inadequate education services Hunger; homelessness; denial or delay of benefits; utility shut offs Henize, Kahn (2013)

Lessons Shared vision – change outcomes, close the gap - and intentionality (thank you, Ozie) Population denominator approach Otherwise great silos, lousy outcomes Measurement and analytic capacity Building network of partnerships Span missions, but also daily operations, data Building innovation and improvement capacity community capacity for design thinking, QI, measurement Funding – hospital, foundation, … ACO?