2. What does the future hold for community health assessment? A look at how one community in Portland, Oregon is collaborating with four local health departments and 14 non-profit hospitals to conduct a regional community health needs assessment Healthy People 2020-National Association of County and City Health Officials Partnership

3. Christine Sorvari and Beth Sanders of Multnomah County Health Department in Portland, Oregon are facilitating a four county community health needs assessment involving four county health departments and 14 non- profit hospitals within the Portland metropolitan area. What’s happening in Portland? Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

4. Meet the assessors! Christine Sorvari, Research Analyst Multnomah County Health Department Beth Sanders, Research Analyst Multnomah County Health Department Priscilla Lewis, Executive Director for Community Services & Development Providence Health & Services Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople (Click on one of the speaker icons to hear from Christine, Beth, or Priscilla)

5. Assessment, Accreditation, and the Affordable Care Act The launch of national public health department accreditation in September 2011 increased the visibility of community health assessment, requiring local health departments to submit a community health assessment and a community health improvement plan as prerequisites to applying. Provisions of the Patient Protection and Affordable Care Act of 2010 require each non-profit hospital facility in the United States to conduct a community health needs assessment and adopt an implementation strategy to meet identified community health needs. Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

6. “Public health leaders and hospital leaders in the Portland area began convening two years ago in anticipation of the accreditation requirements and the Affordable Care Act requirements. Everyone knew it would be a great effort to join all these forces together.” - Beth Sanders, Multnomah County Health Department Coming Together Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

7. “It was the Affordable Care Act that changed this from a polite conversation with our hospital colleagues to a more urgent and committed conversation.” - Priscilla Lewis, Providence Health & Services Polite Conversations Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

8. Sorvari and her team are using their past experience with Mobilizing for Action through Planning and Partnerships (MAPP) to help inform this assessment. MAPP is a community-driven strategic planning process for improving community health and is a framework that many communities use to conduct a community health assessment. Building on MAPP Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

9. “We made a lot of mistakes [the first time we conducted MAPP]. It’s been great to have that experience. Portland is a place where everyone and every organization, non- profit and government, really values community input and community engagement.” - Christine Sorvari, Multnomah County Health Department MAPP and Community Engagement Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

10. Using Healthy People 2020 Healthy People 2020 provides science- based, 10-year national objectives for improving the health of all Americans. “We have an epidemiology workgroup that is conducting the Community Health Status Assessment of the MAPP process, and they created their own methodology on how to prioritize a lot of different health information. One of the criteria includes comparing regional data to Healthy People 2020 objectives.” - Beth Sanders, Multnomah County Health Department Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

11. The four county community health needs assessment includes Multnomah County, Washington County, and Clackamas County of Oregon, and Clark County in Washington State. Working across Four Counties Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

12. “The four counties are very different and they cross over two states. When I made the proposal to be a convener of this assessment, I asked myself whether I could be neutral when I work for Multnomah County. We by far have the most people and the most resources. My response is that we can’t be completely neutral, but I am very conscientious to try.” - Christine Sorvari, Multnomah County Health Department Acting as a Convener Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

13. “It makes sense to include Clark County in this community health needs assessment since Vancouver, Washington and Clark County are all part of the same metropolitan region around Portland. The system may be structured a little differently in Washington but it hasn’t been a major challenge.” - Beth Sanders, Multnomah County Health Department Working across State Lines Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

14. “Patients living in Washington State are right across the jurisdictional boundary but they get a lot of their services here in Oregon. Clark County is the natural service area of these hospitals and where patients live.” - Priscilla Lewis, Providence Health & Services Defining Community Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

15. “We just live in a very different world. Public health is a very deep expertise. In those areas [the hospitals] are really scrambling to catch up. There have been some really fun conversations where I can see the hospital people getting brain cramps from listening to the epidemiologists. On the public health side, it’s really fascinating for me to realize how insulated they are from the amount of care, the patient volume, and the dollar volume of care that goes on within the four walls of our hospitals. That sounds sort of naïve, but it’s obvious that we just operate in two very different worlds. - Priscilla Lewis, Providence Health & Services Speaking Two Different Languages Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

16. “As the convener, I found it challenging to negotiate between unknowns of what hospitals may think public health is about and what public health thinks hospitals are about. Another challenge is I don’t think the partners fully understood the amount of work the epidemiologists would need to do. I just don't think anyone could have known since it is a new type of project. That has been another limitation in this first year.” - Christine Sorvari, Multnomah County Health Department Challenges to Collaboration Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

17. “I’ve been really pleased with people’s level of commitment. All meetings are very well attended. People are putting in a lot of time outside the meetings. Often times this is additional work to their regular day jobs, so I think the level of commitment and enthusiasm has been somewhat surprising to me and really refreshing.” - Priscilla Lewis, Providence Health & Services Commitment to the Assessment Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

18. “We’re learning as we go. Everyone is really pleased and there is lots of enthusiasm on both sides. You never know what you’re going to learn, or what your successes or challenges might be. But just come to the table and develop a relationship; that’s always the first step.” - Beth Sanders, Multnomah County Health Department Learning as We Go Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople

19. Beth Sanders, Research AnalystChristine Sorvari, Research AnalystMultnomah County Health Department Priscilla Lewis, Executive Director for Community Services & Development Providence Health & Services Many thanks! Healthy People 2020-NACCHO Partnership, National Association of County and City Health Officials, http://www.naccho.org/healthypeople (2013)http://www.naccho.org/healthypeople