NY State Community Health Partnership Milbank Memorial Fund
Partners in Community Health:
Working Together for a Healthy New York 1998

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Community Health Improvement

Arbor Hill Community Center, Albany
Dutchess Health 2000
Health Action, Priorities for Monroe County
Partnership for Healthier Communities (Precursor to Healthy Capital District Initiative)
Healthy Capital District Initiative
Livingston County, Working Toward a Healthy Community
Lourdes Hospital, Northside/Eastside Coalition, Binghamton
Oak Orchard Community Health Center, Brockport
Partnership for a Healthier Hoosick Area
Police Department of the City of Amsterdam
St. Josephís Hospital Health Centerís Wellness Program
Suffolkís South Shore Health Partnership
The North Tonawanda Health Summit





ARBOR HILL COMMUNITY CENTER
ALBANY




Mission/Purpose

The mission of the Arbor Hill Community Center (A.H.C.C.) is to provide nutrition education and food services to at-risk youth ages 5 to 21. Nutrition program participants receive a hot, nutritious USDA-approved meal each weekday. During the summer months, youth are provided with three meals and two snacks a day. In addition, youth are engaged in instructional activities that teach positive, proper nutritionófor example, healthy eating and food combinations. Participants also assist in the preparation of the various meals as a teaching/learning exercise.


Programs

After School Nutrition Program
The Nutrition Program provides meals to families and children on a year-round basis. Children receive hot dinners five days a week. On a weekly basis, 150 participants are served.

Food Pantry
The Food Pantry offers food for needy families in Arbor Hill and surrounding communities. The pantry operates three days a week and serves over 250 families per month.

Shut-ins
Meals are delivered to low-income family members who, because of illness or physical limitations, are shut-ins.

Walk-ins
Meals for walk-ins (families and individuals who are unable to secure adequate amounts of food) are provided three days a week, four hours per day. Mealtimes are from 10:00 a.m. to 12:00 p.m. and 1:00 p.m. to 3:00 p.m.

Food Baskets
The Arbor Hill Community Center provides special food baskets during the holidaysóChristmas, Easter, and Thanksgiving. The Center also provides food baskets to persons living with HIV/AIDS.

Food Delivery
Food is prepared and delivered to needy families in Arbor Hill and other communities.

Aerobics Classes
The Arbor Hill Community Center is currently instituting an evening program to address the physical health of women and men through aerobics and exercise.

Stress Management
The agency is currently reorganizing its stress management and wellness classes to better address the needs of community residents in their everyday lives.

The Center has an in-house and external referral system for couples dealing with domestic violence and for displaced homemakers.

Funding
The Arbor Hill Community Center is also supported programmatically by the USDA, New York State Department of Health, Urban League of Northeastern New York, Inc., Whitney M. Young Jr. Health Center, and the Albany Housing Authority Summer Food Programs.

Contact: Janice Parker, Arbor Hill Community Center, 50 North Lark Street, Albany, NY 12210. Telephone: (518) 463-1516. Fax: (518) 463-2217.

Flyer available upon request.

See map, C10





DUTCHESS HEALTH 2000




Mission/Purpose

Dutchess Health 2000 was organized to create a systematic, priority-based process in Dutchess County, New York, which would improve the overall health of residents through a collaborative community effort. Dutchess Health 2000 is a community-driven process rather than a point-in-time research and planning project. The implementation phase is ongoing and begins with health assessment.


The Process
In the summer of 1994, a community advisory committee consisting of 16 organizations was formed to address the unmet needs of Dutchess County residents. The committee was named ìDutchess Health 2000.î It began a process whereby community organizations would work together to identify and address unmet health needs of residents living in Dutchess County. In October 1994 Dutchess Health 2000 retained a health care research and planning firm to assist in completing a community health needs assessment and community health improvement planning process.

Representatives of Dutchess Health 2000 met to discuss goals and what could be done to improve the quality of life for Dutchess County residents. The group consisted of representatives from hospitals and social and health service agencies, local physicians, community leaders, representatives from local business, law enforcement officials, and local colleges. The committee was asked to coordinate and actively participate in the first two phases of the community health improvement process: assessment and planning. In December 1994 Dutchess Health 2000 met to review the community health needs assessment process and topics for a health status and risk behavior survey to be distributed to households in Dutchess County. The final work session was held ten months later in October 1995.


Resource Inventory
The health care planning consultant compiled a summary report of health and human service agencies available to meet the needs of Dutchess County residents. This resource inventory included the name, service area, and a brief description of the services offered by organizations currently addressing the concerns identified by the group. It would assure that community efforts and resources were not duplicated as Dutchess Health 2000 members initiated the planning process. The resource inventory also assisted the committee as they began to identify potential task group members for selected needs.


County Health Profile
Key secondary data from Dutchess County detailing relevant health and social statistics for the county and the state was reviewed. The county profile provided an initial picture of the mortality, morbidity, and fatality issues facing it.


Household Survey Process
The committee then contributed their input to the design of a health status and risk behavior survey instrument, based upon their review of the information from the health profile as well as their experience living with and serving the residents of Dutchess County. The purpose of the survey was to gather primary health status and risk behavior information not available elsewhere.

In February 1995 the household survey was randomly distributed through the mail to 10,000 households in Dutchess County. A total of 1,449 surveys were adequately completed and returned to the consultant. Once the surveys were analyzed, a presentation of data was given to the committee in April 1995. The survey identified the following areas of health concerns for residents of Dutchess County: depression, guns/street violence, smoking, domestic violence, the elderly, and adolescents.


Focus Groups
Based upon the household survey results, the committee selected six topics to be addressed in focus group discussions. The purpose of the focus groups was to facilitate discussion about why various problems existed in the county. Focus groups also served to explore issues that were not covered in the household survey, such as adolescent issues. The following six areas were identified by the committee as focus group discussion topics: inner city/homeless health, mental health, adolescent health, access to care, domestic violence/street violence, and patient education/consumer awareness.


Community Health Forum
In September 1995 Dutchess Health 2000 hosted a Community Health Forum to further explore the health concerns identified through the survey findings and to discuss with community residents potential ways to address those needs. More than 50 health and human service providers attended the Health Forum. Participants gave input relative to each area of concern. Participants discussed why the identified concerns exist in Dutchess County, suggestions for improving the health of Dutchess County residents relative to each area of concern, and which organizations should be involved in future task groups charged with implementing strategies to improve health.


Strategic Planning Process
The Dutchess Health 2000 Committee received a comparison summary of selected health status and risk behavior indicators, including Dutchess County household survey results, results from the consultantís national survey, and Healthy People 2000 goals. Prior to the planning session, the group also reviewed findings from the Community Health Forum and key findings from the household surveys.

On the first day of the planning session, following a discussion about the Health Forum and research findings, each of the six health concerns were refined into three specific categories of concern. On the second day, the Dutchess Health 2000 group addressed these needs as follows:


Community Implementation Strategies
Dutchess Health 2000 proceeded to develop strategies to address the needs identified at the Community Health Forum. They also developed objectives relative to each need and a preliminary listing of potential community organizations and representatives to be considered for inclusion in task groups. This preliminary list was intended to serve as a starting point for the creation of these groups.


Organization
The six priority areas identified by the Dutchess Health 2000 assessment process were organized as follows:

Task groups under Dutchess Health 2000:


Task groups under guidance of other organizations:

Task groups to be addressed in partnership with other organizations:


Vision
Dutchess Health 2000 is a partnership of entities from the public, private, and nonprofit sectors collaborating to improve the health of Dutchess County residents. Its vision is to create the healthiest community in New York State.

Leadership Role

Donald F. Murphy, executive vice president and chief executive officer of Saint Francis Hospital, organized Dutchess Health 2000 in consultation with other community leaders. Its origin was based on the observation that the county did not have an organized, comprehensive health assessment and health improvement strategy. After gaining the support of the county executive, the president of the United Way, and other community leaders, 16 organizations were recruited to collaborate in improving the health of Dutchess County residents.

While Dutchess Health 2000 is in the process of applying for nonprofit corporation status, it is governed by a steering committee made up of representatives of member organizations and other individuals committed to improving the health of the community.

Don Murphy, who provided leadership from the organizationís inception, chairs the committee. Saint Francis Hospital provided administrative support for the committee, although all members have provided support when called upon.

The Steering Committee, with the assistance of the consultant, developed the community needs assessment, identified issues to be addressed, and participated in the Community Health Forum in September 1995. The committee identified task forces to address unmet health needs and to give feedback when appropriate.

The chairman successfully secured funding from a local foundation to hire an executive director. The director was hired in August 1997 and was charged with overseeing the activities of the task forces, seeking funding for programs, and providing other support identified by the chairman and the committee.

The collaboration has been successful to date because the organization has not been ìtop-heavyî and consensus has been reached without special interests prevailing. Financial and in-kind contributions have been made by many of the members, ultimately resulting in an effective, nonduplicating community collaborative.

Key Partners/Stakeholders

Participating Organizations in Dutchess County 2000 are: AARP; Central Hudson Gas and Electric Corporation; Childrenís Medical Group; Community Health Plan; Community Foundation of Dutchess County; Dutchess County Department of Mental Hygiene; Dutchess County Executive; Dutchess County Health Department; Dutchess County Medical Society; Dutchess County Sheriffís Department; Dutchess County Stop DWI; Eastern Dutchess County Rural Health Network; Harlem Valley Partnership; IBM Corporation; Laerdal Medical Corporation; Marist College; McCann Foundation; Medicus Immediate and Occupational Health Services; Mid-Hudson Library System; Mohawk Valley Plan; Northern Dutchess Hospital; Poughkeepsie City School District; Saint Francis Hospital; Sharon Hospital; SPARC/Berkshire Taconic Community Foundation; United Way of Dutchess County; Vassar Brothers Hospital; Wellcare Management Group.

Members of the Steering Committee included the following: Don Murphy, Executive Director and CEO, Saint Francis Hospital, Chairman; Ronald Lipp, Executive Director, Dutchess Health 2000; Charles Leven, New York State President, AARP; Dave Klocker, Employee Benefits Supervisor, Central Hudson Gas and Electric; Joseph Heavey, Administrator, Childrenís Medical Group; Pat Wright, Executive Director, Community Foundation of Dutchess County; Michael Caldwell, M.D., Commissioner, Dutchess County Department of Health; Sabrina Jaar-Marzouka, Director of Health Planning and Education, D.C. DOH; Kenneth Glatt, Ph. D., Commissioner, Dutchess County Department of Mental Hygiene; Nina Lynch, Dutchess County Office for the Aging; Betsy Brockway, Director, Dutchess County Youth Bureau; Harold Brilliant, Administrator, Dutchess County Stop DWI; Ron Gauch, Ph.D., Professor of Management, Marist College; Kristen Jemiolo, M.D., former County Legislator; Anne Jordheim, Ed.D., Health Educator, retired; Joseph DiPalo, Chief Operating Officer, Medicus; Barbara Lindsley, Video Project Director, Mid-Hudson Library System; Cindy Neal, Northern Metropolitan Hospital Association; Connie DeFreest, Vice President, Saint Francis Hospital; Peter Leadley, M.D., Vice President, Medical Affairs, Saint Francis Hospital; Helen Byron, Director Case Management, Sharon Hospital; Donna DiMartino, Associate Director, SPARC/Berkshire Taconic Community Foundation; Anna Timell, M.D., Director, Eastern Dutchess County Rural Health Network; Jason Zaccaria, Administrative Director, Vassar Brothers Hospital; Monika Boeckmann, Director Community Initiatives, United Way of Dutchess County; John Farrell, Vice President Finance/Administration, Laerdal Medical Corporation.


Membership Recruitment
Participating organizations and individuals to serve on the Steering Committee are recruited through continued development of the collaboration. Twelve additional organizations were added to the original sixteen. Dutchess Health 2000 is committed to encouraging diversity and expanding representation of the community. The following organizations have been approved by the Steering Committee for recruitment over the next year: Chambers of Commerce; Faith Community; School Nurse; Dutchess County BOCES; Dutchess Community College; Vassar College; American Heart Association; American Cancer Society; Family Partnership Center.


Decision-Making Process
Dutchess Health 2000 is governed by a Steering Committee that comprises representatives of member organizations and other individuals committed to improving the health of the community. Decisions are made through consensus. The committee has continued to operate as a true community collaborative since its inception in 1994 and therefore no special interests prevail. Chairs of the task forces organized by Dutchess Health 2000 serve on the Steering Committee, thereby assuring effective communication and governance. These chairs represent adolescent, elderly, and mental health issues, respectively. A Department of Health official represents tobacco and smoking issues. These designations are consistent with the organization described previously.


Roles of Partners
Most of the original member organizations made a financial commitment toward the costs associated with the consultant services. Since the initial financial contributions and grants, all members have made in-kind contributions toward the health and improvement process. The mix of health care providers, government agencies, nonprofit agencies, businesses, and other stakeholders has assured the opportunity to share the effort. Under the chairmanís leadership and the support of Saint Francis Hospital, the collaboration has evolved into a true partnership dedicated to addressing health improvement for Dutchess County residents.


Impact/Effectiveness


Mental Health
Since nearly 20 percent of Dutchess County households surveyed reported having a family member who has been treated for a mental health problem, and 75 percent of those were treated for depression, a Mental Health Task Group was formed. The group was charged with addressing inappropriate care, insurance coverage and financial concerns, and stigmatization of mental health problems. The seven-member task group comprises representatives of the County Mental Health Department, a state hospital, a community hospital and mental health clinic, the Mental Health Association, and private practitioners. A Community Mental Health Grand Rounds was organized by the group to bring staff together from multiple community agencies to network; seek ways to increase communication and cooperation; identify opportunities for delivery system improvements; engage managed care companies in a dialogue regarding financial concerns; and promote collaboration between educational, criminal justice, and social service agencies and mental health providers. Following a successful meeting in a town hall format, four priorities were established. They included continuity of care; early intervention and communication among providers, school personnel, and parents; managed care issues; and medical care integration with the mental health system. A Managed Care Subcommittee was created to survey county mental health providers about their experiences with managed care organizations and clinical care outcomes. A second subcommittee was formed to strengthen communications among school officials, parents, and mental health providers. A second Community Mental Health Grand Rounds attracted 110 mental health professionals, further strengthening the foundation of the Mental Health Task Group. While outcome measures have not yet been developed, the new organization created by mental health professionals is commendable.


Elderly Issues
The household survey revealed that a high percentage of older citizens were not knowledgeable about services available to them. Additionally, many elderly felt isolated, especially in the rural areas. The Elderly Issues Task Group, in conjunction with Catholic Charities, began to establish health ministry programs through parishes and congregations. Five programs were initiated in the county whereby volunteers are recruited within congregations in an effort to provide outreach, referral, and health screening services to congregants. Committee members assisted clergy and volunteers in the organization and implementation of the programs. The goal is to create similar volunteer efforts in as many congregations as possible.

The Elderly Issues Task Group was reorganized in the spring of 1998. Thirty-two members were recruited, representing health and human service providers, government and nonprofit service agencies, senior housing managers, academicians, and other stakeholders. The group will divide its human resources into three subcommittees: health promotion, provider education, and data development (for measurement and evaluation).


Adolescents
Using input from the Adolescent Focus Group and the Community Health Forum, a task force was formed by the Steering Committee. The task force was charged with focusing on three priorities: smoking, self-esteem issues, and drug and alcohol use. The Adolescent Health Task Force was reorganized in 1998 with the appointment of the director of Dutchess Countyís Youth Bureau as its chairperson. Under Ms. Brockwayís leadership, Dutchess Health 2000ís resources will be integrated with existing efforts in the county. This alignment allows for a strengthening of the coalition and brings more assets to the effort to address youth-related issues. A youth needs survey was conducted in 1997 throughout Dutchess County schools to assist with priority-setting. A Youth Violence Prevention Coalition began working on an Asset Building Program for youth. Also during 1998, a Children Services Council was formed to bring together representatives from all agencies and organizations involved with the delivery of services for youth. With widespread representation, the council will be identifying countywide indicators and integrating planning for children, youth, and families.


Domestic Violence
The task force, originally spearheaded by Patricia Dogil of Saint Francis Hospital, met with representatives of agencies related to domestic violence. Throughout 1996 this task force worked on projects designed to increase caregiver awareness of the problem. Inservices for nurses have been held at Vassar Brothers, Saint Francis, and Northern Dutchess Hospitals to increase awareness and to train personnel in recognizing signs of violence. The annual Saint Francis Hospital medical staff meeting included a speaker on domestic violence.

The task group, in conjunction with the Mid-Hudson Health Education Department and the Dutchess County Domestic Violence Consortium, coordinated a community health caregivers education/awareness program, which was held in November 1997. Over 200 health care professionals attended the ìDomestic Violence Conference for Health Care Professionals.î Its keynote speaker was Dr. Sheila Smythe, a renowned expert on interpersonal violence. The target audience of the program included emergency room staff, home care agency representatives, health maintenance organizations, family practice residents, physicians, EMS personnel, and other health care providers. Continuing education credits were provided.

Mary Walsh, M.S.W., was appointed the new Domestic Violence project coordinator. She and the group continue to pursue other projects, including a patient education video, standard policy/procedure for domestic violence, care maps, and mandatory worksheets for all hospitals.


Resources
Through a grant from the Dyson Foundation, an executive director was hired in August 1997 to oversee task group activities and provide staff support for the organization. Saint Francis Hospital provides office space and administrative support. Volunteer efforts by numerous partners have provided the impetus for the majority of the activities and programs since Dutchess Health 2000ís origin in 1994. Efforts will be made to obtain additional funding to support programs identified by the task groups. Tools for measuring outcomes must be established. Frustration exists because timely and accurate data are not readily available. An opportunity exists for Dutchess County to join with other Mid-Hudson counties in establishing a health data system that would not only assist Departments of Health but community health collaboratives, like Dutchess Health 2000, with useful measurement tools.


Community Support
Through a combination of the leadership of its organizer, the commitment and support of county government, and the willingness of numerous partners to participate in a true community collaborative, Dutchess Health 2000 has reached its current stage of development. Working closely with the Department of Health, the United Way, hospitals, and other health providers, the organization has the opportunity to reach out further to other stakeholders. Community support is positive and the environment is appropriate for expansion of the effort. A Web site is under design with support from the New York State Department of Health. The site will make accessible the complete Dutchess Health 2000 report and enhance communication among its partners and the community.


Contact: Ronald F. Lipp, Executive Director, Dutchess Health 2000, c/o Saint Francis Hospital, 35 North Road, Poughkeepsie, NY 12601-1399. Telephone: (914) 431-8847. Fax: (914) 485-3762. E-mail: rlipp@sfh-mhh.org

See map, D3





HEALTH ACTION, PRIORITIES FOR
MONROE COUNTY




Mission/Purpose

Health Action, Priorities for Monroe County, began in 1995 when the director of the Monroe County Health Department convened a group of community partners to develop a plan to improve the health of Monroe County residents. These partners included the Finger Lakes Health Systems Agency, the Center for Governmental Research, Finger Lakes Blue Cross and Blue Shield, Preferred Care, the Hospital Consortium of Greater Rochester, the University of Rochester, and the Rochester Health Commission. This steering committee has recently been expanded to include the Industrial Management Council, the Chamber of Commerce, the Association of Independent Health Centers, the Monroe County Medical Society, and three integrated health systems: ViaHealth, Unity, and Strong Health.

Partners in Health Action are committed to making Monroe County a healthy community by the year 2020. Our definition of a healthy community is one in which the objective measures of health status are at optimal levels and there exists a commitment to health at all levels of the community, including individuals, families, neighborhoods, community-based organizations, schools, churches, businesses, health care providers, and government. This commitment is required in order to achieve improvements and institutionalize a continuous improvement effort.

To achieve this vision, it is necessary to set in place a strategy to improve community health.

This strategy was developed over the first year of Health Action and was subject to review and comment by members of the steering committee, the board of health, and subcommittees of the board. As will be discussed later, intervention strategies to address priority health problems will involve collaboration among and between service providers, community-based organizations including schools and the faith community, and others who have a stake in the particular issue being addressed.


Leadership Role

The Monroe County Health Department convened community stakeholders to develop Health Action and remains the lead agency by consensus of the steering committee. In the highly competitive health care environment in Monroe County, the health department is viewed as the appropriate facilitator for developing synergy among health care providers and between health care providers and community-based organizations.

The steering committee has defined the mission and vision of Health Action, defined roles and functions, and recruited members. Decisions are made by consensus. At this point there are no formal bylaws.

The board of health has been designated to manage the priority-setting process and to mobilize action coalitions to address priorities. The board committee structure has been realigned to support the activities relating to Health Action. Committee roles, responsibilities, and lines of communication have been defined.

The Center for the Study of Rochesterís Health, a collaboration between the Monroe County Health Department and the University of Rochester, will be a resource to Health Action in analyzing community data, defining interventions, and developing evaluation strategies for each intervention. One of the functions of the center is to initiate multidisciplinary studies to analyze community-level data, evaluate public health practices, and assess the impact of changes in the health care delivery system in Rochester and throughout Monroe County. The deputy director of health is also the director of the center.

The director of health, deputy director, and manager of health administration take the lead in the design and implementation of Health Action, with significant involvement of department staff and steering committee and board of health members. Funding has been established to provide technical assistance to Health Action partnerships in the areas of team building, leadership, negotiation, conflict resolution, quality improvement and problem-solving processes, and systems issues. These activities will enable the community to strengthen its base of skilled leaders and broaden the pool of potential membership for Health Action partnerships. In addition, the steering committee has established a communications subcommittee that will oversee the communications plan for Health Action, plan press events, and provide technical assistance to partnerships in the development of communication plans for interventions.


Key Partners/Stakeholders

Each organization on the steering committee is represented by the CEO or by a high-level staff person who has been authorized by the CEO to act on behalf of the organization in making decisions and commitments related to Health Action. Membership has recently been expanded to assure the involvement of businesses in the community. Members of the steering committee have signed Memoranda of Agreement to formally commit to Health Action.

The board of health is appointed by the county legislature. Members of the subcommittees of the board represent community organizations that are stakeholders in the improvement of health for each focus area, as do members of the Health Action partnerships. Partnerships are not limited to health care organizations. Included are representatives from community-based organizations such as Action for a Better Community, Monroe Council on Teen Pregnancy, settlement houses, and churches.

Health Action is guided by the steering committee. Responsibility for assuring community involvement in terms of establishing priorities for action falls to the board of health. Each Health Action partnership has responsibility for further definition of the priority goals and development of intervention and evaluation strategies.

Over time, it is the goal of Health Action to broaden the base of participation to towns, villages, neighborhoods, and individuals.


Impact/Effectiveness

Health Action will be evaluated on two levels. For each intervention, an evaluation plan will be developed with the assistance of the Center for the Study of Rochesterís Health. On the community level, progress will be evaluated by assessing changes in the measures for each goal on the report card, which will be updated every two years. Every four years, priorities for action will be reviewed and possibly revised.

Below is a definition of the process and Health Actionís progress to date with respect to each:


Assess Health Status
Plans to improve health status should be based on community data. To accomplish this, the steering committee has established five subcommittees to develop community health report cards in the following areas: Maternal/Child Health, Adolescent Health, Adult Health, Older Adult Health, and Environmental Health. These committees are charged with compiling and analyzing data to identify measures of health status for each of the report cards, identifying five to ten goal areas, preparing report cards for publication, and making recommendations about priorities for intervention. New data sources are developed as neededófor example, a local randomized telephone survey of adults was conducted in 1997.

Progress to Date: The Maternal/Child Health Report Card was published in May 1997 as part of a report entitled ìFurther Down the Pathway. . .,î and the Adolescent Health Report Card was released for review and comment in October 1997. The Adult Health Report Card is to be released in late summer 1998. The Older Adult Report Card is scheduled for release in early fall 1998 and the Environmental Health Report Card in late fall.


Choose Priority Goals
As each report card is developed, the board of health interacts with community stakeholders for each focus area to determine the priorities for action. Input is gathered from a wide variety of stakeholders including health professionals, community-based organizations, parents, and other providers of services. Considered in this process are the importance of each goal, how easy it was to effect change, resources needed to accomplish interventions, and the relative cost and time required. Results are then collated and priorities for action established.

Progress to Date: The Maternal/Child Health subcommittee of the board gathered input from the community about each of the seven goals in the report card. Two were identified as priorities for action: Improving Birth Outcomes and Improving Access to Preventive Services. For Adolescent Health, the board will soon vote on the two goals recommended by the Adolescent Health subcommittee: Reducing Tobacco Use and Improving Mental Health.


Define the Leadership
To address the goals that are chosen as priorities for action, we will convene Health Action partnerships composed of representatives from many sectors of the community. For each priority, the Health Action partnership will review the current activities in the community, determine the most effective interventions, plan and coordinate new interventions for the community, and evaluate their effectiveness.

This step involves identifying the existing resources in the community that may assume leadership in addressing a priority area. Input is received from steering committee members, the board of health and its subcommittees and department staff. If there is no clear lead in the community, there may be a need to establish a new partnership.

Progress to Date: For the two goals chosen for Maternal/Child Health, Health Action Partnerships are actively meeting and considering new approaches to address the goals.


Develop Improvement Plans

Interventions should be based on what is known about best practices and be focused on the areas where the most impact can be made. Community sponsors for each priority, with technical assistance as needed from the Center for the Study of Rochesterís Health, will analyze the critical factors contributing to health problems and develop comprehensive, multipronged plans to address them.

Progress to Date: The partnership addressing Improving Birth Outcomes has received a one million dollar/year Healthy Start grant for three years and has a plan in place for intervention and evaluation. The partnership addressing Improving Access to Preventive Services is developing a strategy to assure access to insurance and preventive services and is developing an outcome-based evaluation strategy.


Perform Interventions
Interventions will be performed by member agencies of the Health Action partnerships based on the comprehensive health improvement plans described above.


Measure the Impact
Sponsors of community interventions have little expertise in and limited funding for formal program evaluation. The Center for the Study of Rochesterís Health will provide technical assistance to the Health Action partnerships in evaluating the impact of interventions.


Assess Health Status
Reports of progress toward goals will provide feedback to the community and provide a basis for the next planning cycle. Each report card will be updated and published every two years.

The overall goal of Health Action is to improve the health of the citizens of Monroe County by aligning community resources to focus on a few priorities. Community stakeholders are excited about the opportunity to work collaboratively on a few priority areas for health improvement. Health Action facilitates collaboration and cooperation among providers, agencies, and businesses that in other arenas might be seen as competitive. This collaboration will benefit the community by concentrating resources where they are most likely to have an impact on health status.

Community interest and involvement is building rapidly. The board of health subcommittees have conducted surveys and focus groups with families, health care providers, schools, and other groups in our community to gather information about which goals were seen as priorities for action for Maternal/Child Health and Adolescent Health. These activities were the first step in raising awareness. An official kickoff for Health Action was held on April 1, 1998, with follow-up meetings with the press and a subsequent editorial supporting the project. Many presentations have been made to community groups about Health Action. The first of quarterly newsletters was published in late March. A pamphlet describing Health Action was also developed.

A communications plan for the overall project has been developed. As each Health Action partnership is founded and intervention strategies defined, appropriate communications will be key to involving the community.

Contacts: Monroe County Health Department, P.O. Box 92832, 111 West Fall Road, Rochester, NY 14692.

Andrew S. Doniger, M.D., M.P.H., Director of Health. Telephone: (716) 274-6068. Fax: (716) 274-6115. E-mail: adoniger@mcls.rochester.lib.ny.us

Nancy M. Bennett, M.D., Deputy Director of Health. Telephone: (716) 274-6080. Fax: (716) 274-6115. E-mail: bennett@prevmed.rochester.edu

Cheryl A. Utter, R.N., M.S., M.B.A., Manager of Health Administration. Telephone: (716) 274-8446. Fax: (716) 274-6115. E-mail: cutter@mcls.rochester.lib.ny.us

Materials available upon request (limited number of copiesómay be reproduced):

Report Cards

Maternal/Child Health

Adolescent

Adult

Older Adult

Environmental Health (after January 1, 1999)

Health Action Newsletter
Health Action Brochure


See map, A9





PARTNERSHIP FOR HEALTHIER COMMUNITIES
(PRECURSOR TO HEALTHY CAPITAL
DISTRICT INITIATIVE)




Formed in 1995, the Partnership for Healthier Communities represented the first major collaboration between the Albany County Health Department and three major providers of health care services.

Prior to 1995 the Albany County Health Department ran three primary care clinics; two were located in economically disadvantaged inner-city communities and one was located in a rural community. Assuring high-quality care was a constant challenge for Albany Countyórecruiting per diem physician staff for the clinics, arranging for after-hours coverage, paying for malpractice insurance, arranging for appropriate referrals to specialists when needed, and connecting eligible patients to a choice of Medicaid managed care plans.

Three of the areaís largest health care providers decided to respond to the countyís formal request for assistance in meeting these challenges. The providers included Mercycare Corporation/St. Peterís Hospital and Seton Health, both major Catholic-sponsored health systems in the Albany area, and the Whitney M. Young Jr. Health Center, a federally qualified health center.

The three providers had a number of existing linkages among themófor example, specialty referrals, physician cross coverage, and staff education and developmentóand had sponsored a number of primary care centers, many located in underserved areas of the county. In addition, the catchment areas of these providers matched the catchment areas of the County Health Department clinics. The opportunity to respond to the countyís needs met the Catholic health systemís mission of services to the poor and the neighborhood health centerís mission of caring for the underserved.

Over the course of a year, the county public health clinics were phased out and patients were offered the opportunity to choose a new medical homeóoffered through one of the three partnersí health centersóproximate to where they resided. In addition to having better access to more primary care sites, an identified primary care physician, more choices for Medicaid managed care, and an opportunity to enroll in Child Health Plus, patients now have far greater access to such resources as social work, specialty care, and diagnostic services. The County Health Department reallocated resources previously designated for clinics to the following population services: STD and TB services; the expansion of immunization programs to include hepatitis B, travel, and other adult immunizations; and the expansion of the number of community health workers available to work with individuals, families, and community groups on domestic violence and teen pregnancy. These workers also assisted partnership health centers with community outreach and education. No-show rates for appointments have been reduced dramatically.

The partnership stimulated a ìHealthy Communitiesî initiativeóHealthy Capital District Initiativeónow spanning three counties and including all hospitals, public health departments, three county medical societies, all managed care payors, two federally qualified health centers, Catholic Charities, Center for the Disabled, and the Veterans Administration Medical Center. The partnership is expanding to include other sponsors as well.

A description of the Healthy Capital District Initiative follows on page 97.

See map, C10





HEALTHY CAPITAL DISTRICT INITIATIVE




Mission/Purpose

Formally established in 1997, the Healthy Capital District Initiative (HCDI) represents an unprecedented collaborative effort to develop a strategic action work plan designed to improve the health of the residents of Albany, Rensselaer, and Schenectady Counties. This initiative comprises the capital districtís major health care providers and insurers, the three local medical societies, and the three local governments. All have provided seed money and in-kind support for the initiative. In addition, the New York State Department of Health (NYSDOH), the Robert Wood Johnson/ Kellogg Foundations (through the Turning Point Initiative), and the Community Foundation for the Capital Region have all provided funding support for the project.

The Healthy Capital District Initiative was undertaken in the spirit of Communities Working Together for a Healthier New York, a statewide project initiated by the New York State Department of Health that made use of community forums to identify high-priority public health concerns. It is also a direct response to the changing health care environmentóan environment in which cooperative community efforts to improve health have become an essential tool in efforts to maximize health while minimizing costs.

The vision represented by this project is a new approach to addressing issues in the tri-county area. The primary working group of the Healthy Capital District Initiative consists of a ten-member Planning Committee composed of representatives of the sponsoring organizations. The Council of Community Services of NYS, Inc., and the University of Albanyís School of Public Health provide consultation support to the initiative.

The vision of the Healthy Capital District Initiative is to foster healthy people in the healthy communities of New York Stateís capital district counties of Albany, Rensselaer, and Schenectady. Its mission is to mobilize all segments of the community to make measurable and sustainable improvements in selected and prioritized public health conditions in these counties.

In pursuit of its mission, the Healthy Capital District Initiative seeks to achieve the following goals:

Goal 1
A strong public health infrastructure and community health delivery system that is responsive and accountable to regional and local community needs and constituencies.


Goal 2
A cost-effective and accessible primary and preventive care system.


Goal 3
Regional and local communities that are knowledgeable and aware of, and assume responsibility for, their health status.


The Healthy Capital District Initiative bases its approach to community health and the projectís mission, goals, and activities on the following guiding principles:


 


 
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