1. 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

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

3. Overcoming Obstacles to Health, Robert Wood Johnson Foundation, 2008

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

5. 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

6. 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 ,
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

7. CCHMC

8. 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)

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

10. Cincinnati Asthma Admissions and Neighborhood Asthma Hotspots

11. Legal Aid Housing Cases Mapped Against Neighborhood Asthma Hotspots

12. 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

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

14. Avondale
Beck (2014)

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

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

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

18. 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:   /j.acap
PMCID: PMC
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

19. 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 ,
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

20. Preterm birth in Hamilton County

21. 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)

22. 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?