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:


1998ñ1999 Focus Areas

The initial focus areas identified by the initiative to be addressed in the first phase of the project include cardiovascular disease and stroke, violence, healthy births, and access to preventive and primary health care. These areas were identified based on research activities and community input via the Health Profile, the Primary Telephone Survey, and the Community Forum.


Access to Preventive and Primary Care
A communityís health is affected by several factors that may result in poor health outcomes. Access to primary health care services, i. e., availability of services and financial access, remains an issue for several communities within the capital district. Without access to primary health care services, not only is primary care being denied but also access to prevention through education, early detection through screening, and treatment. Primary care serves not only as a point of routine health care but also as a referral source for additional needed health and social services.

Frequently identified obstacles to access of primary health care include: a lack of financial resources to pay for services; a lack of primary care providers and/or lack of primary care sites; and individual obstacles such as transportation, cultural issues, education, and/or language. Obstacles presently affecting oneís access to primary health care are as diverse as the individual and the community in which he or she lives.

Continuous quality health care can diminish the effects of long-term chronic health conditions. Therefore, education, early intervention, prevention, and continuity are the key to successful health outcomes.


Leadership Role

The major components of the leadership structure have been addressed above. The Healthy Capital District Initiative was established by representatives of the Albany County Department of Health, St. Peterís Hospital/Mercycare, and Seton Health System. Individuals from these organizations had been collaborating on a ìPartnership for Healthier Communitiesî activity (see p. 95) that involved the transition of medical care from the Albany County Department of Health to major health care providers in the community. Much progress had been made in that area when a conference was held to discuss Dutchess Health 2000. At that time the three representatives from these organizations had lunch and the concept for an initiative was endorsed. Key stakeholders were identified after much discussion and with collaboration with the consultants, Tripp, Umbach & Associates a Pittsburgh-based consulting firm. A kickoff meeting included government leaders; health department officials; executives from hospital and health systems, managed care organizations and HMOs, and federally qualified health centers; and physicians from the three medical societies in the capital district.

The Healthy Capital District Initiative is primarily led by a Steering Committee made up of representatives of the sponsoring organizations. It is led by two cochairs who are members of the Albany County Department of Health and St. Peterís Hospital. Decision making has been accomplished based on a consensus-building model, with all representatives of the Planning Committee having an opportunity to influence proceedings of the initiative. The local health departments and St. Peterís Hospital have served as lead agency on a number of grant activities and all representatives on the Planning Committee have contributed to the design and implementation of project activities.

The Healthy Capital District Initiative has had excellent support from the Council of Community Services and the University of Albany School of Public Health. It has also established a relationship with the Community Foundation of the Capital Region for purposes of fiscal administration and management of community funds that will help to support certain project activities.

The leadership of the Planning Committee has enhanced partnership capabilities and the overall effectiveness of the HCDI. It has assisted in responding to grant opportunities and has been successful in obtaining grant funding from the Robert Wood Johnson/Kellogg Foundations Turning Point grant. HCDI also received major funding from the Community Foundation of the Capital Region and is optimistic about receiving financial support from other sponsoring organizations including the business community.


Key Partners/Stakeholders

The current sponsors of the Healthy Capital District Initiative include the following organizations:

Albany County: Medical Center; Department of Health; Medical Society; Mercycare/St. Peterís Hospital; Childís Hospital; Strattan Veterans Administration Medical Center; Whitney M. Young Jr. Health Center; Albany Memorial Hospital.

Rensselaer County: Department of Health; Medical Society; Northeast Health; Seton Health System.

Schenectady County: Medical Society; Public Health Services; St. Clareís Hospital; Sunnyview Rehabilitation Center; Ellis Hospital; Bellevue The Womenís Hospital; Schenectady Family Health Center.

Health Insurers: Kaiser/Community Health Plan; Capital District Physicians Health Plan; Mohawk Valley Physicians Health Plan; Empire Blue Cross and Blue Shield; Blue Shield of Northeast New York; Wellcare of New York; and Partners Health Plan.

Foundation: Community Foundation for the Capital Region.

Essentially all area hospitals, health insurers and federally funded health centers are involved.

The HCDI founding coalition of 22 sponsors is not incorporated at this time. However, for all practical purposes the sponsors function as the governing body and decisions are made by consensus. Meetings are held every two to three months to monitor progress against the work plan and to review/approve recommendations from the Planning Committee. The sponsors also participate in public relations functions that promote the mission, goals, and objectives of the initiative. CEO attendance at these meetings has been extraordinary. The Planning Committee, which meets weekly and consists of representatives of the sponsors, provides the day-to-day direction. Decisions of the planning committee are made by consensus. The Planning Committee has two cochairs and receives ongoing technical assistance from faculty of the University of Albanyís School of Public Health and from senior staff from the Council of Community Services. It receives additional assistance on select issues from a partner of Tripp, Umbach & Associates and from staff of the Healthcare Association of New York State.

The Planning Committee is supported by a number of subcommittees including:

The sponsors are currently in the process of restructuring the initiative to expand the number of sponsors to include additional representatives. Over 300 organizations in the tri-county region that meet the criteria have been identified by the sponsors. Many of these organizations have been introduced to HCDI and have participated in an all-day Regional Planning Forum that was held on February 26, 1998. In the restructured organization, invitations will be forwarded to many of these groups. The existing sponsors will transition to become the founding sponsors and will serve as the board of directors. The directors will approve the annual focus areas and work plans developed by each of the work groups, approve the operating budget, and participate in the evaluation of staff. The board will also be evaluating the need to become incorporated as a 501(c) (3) charitable organization.

Currently the HCDI has no full-time staff persons. Staff support is provided solely through the generosity of the sponsors.

Current Roles and Responsibilities of the Sponsors are to:


Impact/Effectiveness

HCDI results to date include the following:


Evaluation Methodology
HCDI has found the evaluation criteria to be utilized in the RWJ/Kellogg Foundation Turning Point project extremely useful and has adopted that criteria for all efforts of the initiative.

The criteria are as follows:


Benefits to the Partners


Benefits to the Community


Problems to Overcome

Contacts:

James B. Crucetti, M.D., M.P.H., Commissioner of Health, Albany County Health Department. Telephone: (518) 447-4691. Fax: (518) 447-4573. E-mail: jbc@health.co.albany.ny.us

Joseph F. Pofit, M.S., M.P.H., Vice President for Planning and Communications, Mercycare/St. Peterís Hospital. Telephone: (518) 525-1596. Fax: (518) 525-1520. E-mail: JPOFIT@Mercycare.com

Pamela Rehak, Vice President for Planning and Community Health, Seton Health. Telephone: (518) 268-5517. Fax: (518) 268-5794. E-mail: prehak@global2000.net

Evelyn Williams, Executive Director, Whitney M. Young Jr. Health Center. Telephone: (518) 465-4771. Fax: (518) 432-3632.

See map, C9-11





LIVINGSTON COUNTY
WORKING TOWARD A HEALTHY COMMUNITY




Mission/Purpose

The Livingston County Department of Health took the leadership role in forming a Community Health Assessment (CHA) Committee to assemble, analyze, and review data related to health indices; to identify opportunities to improve the health of the community; and to develop strategies to address the identified needs. Twenty-seven county and community agencies participated in this process, which began in November 1995. A list of the participating members can be found at the end of this description. The committeeís focus was to identify opportunities for health promotion and disease prevention.

The committee agreed from the outset that the health of a community is influenced by conditions that contribute to health. Individuals, businesses, service providers, schools, and various agencies are responsible for creating positive health conditions. The promotion of wellness and prevention of disease and injury are powerful tools for improving the health status of a community.

The CHA Committee reviewed volumes of data including morbidity, mortality, demographic, socioeconomic, and other relevant statistical information. The committee compared Livingston Countyís data to that of a ìpeerî county (one of similar size and population) and to upstate New York data. The committee spent approximately one year analyzing the information in order to identify the health needs of the community. After the data had been presented and analyzed, the committee reviewed the areas that had been identified, either by the data or by anecdotal comments, and listed all topics. A discussion took place, verifying that all members were comfortable with the list, and then the committee, by consensus, determined the top ten ìhealth opportunitiesî for Livingston County. A request for input from the community was advertised in Pennysavers. The format was open-ended and included instructions to tear out the page and return it to the Department of Health. (Return address and prepaid postage were included.) Response totaled 134. The health problems perceived by the community concurred with those identified by the committee. In identifying the priorities, the committee focused on behavioral factors that lead to disease rather than the diseases themselves.

Once the health priorities were identified, work groups were formed to examine each priority and to develop interventions to address them. The committee identified the following as the ten most important health opportunities (in alphabetical order):

The CHA Committeeís vision for a healthy community is to improve the current health status of Livingston County residents. Recently the committee developed a slogan to express its vision: ìWorking Toward a Healthy Community.î


Leadership Role

The Livingston County Department of Health took the lead role in establishing the CHA Committee, and the public health director chaired all of the meetings. The public health director emphasized that:


Key Partners/Stakeholders

Members of the Community Health Assessment Committee and Workgroups included the following:

Lyn Aina, Wyoming County Community Hospital; Jon Barefoot,

Septic System Contractor; Lisa Beardsley, Livingston County Department of Health; Christine Betron, Livingston County Rape Crisis Service; David Bimber, New York State DEC; Dick Bishop, Consumer; Gloria Brand, Livingston County Youth Bureau; Mark Brown, Livingston County Community Services; Barbara Campbell, Livingston County Probation; Laura Canne, Focus on the Children; Nancy Cappadonia, State University of New York, College at Geneseo; Virginia Cassetta-Wilson, Livingston County Department of Health; Peggy Collins, American Lung Association; Lou Ann Conrad, Livingston County Department of Health; Richard Corrigan, Livingston County District Attorneyís Office; Nick Donofrio, Elf Atochem; Laura Elliott Engel, Livingston County Alcohol Council; Joan H. Ellison, Livingston County Department of Health; Joan Flender, M.D., Stoneybrook Pediatrics; Mary Folts R.N.,C., State University of New York, College at Geneseo; Penelope Frontuto, Wyoming County Community Health Service; Debbie Gage, Livingston County Chapter, American Red Cross; Fran Gotcsik, Greenway; Bette Gove, Livonia Nautilus Fitness Center; Deborah Graham, University of Rochester Medical Center; Margaret Harrington, Livingston-Wyoming ARC; Robert Hayes, M. D., Avon Medical Center; Tamara Hayes, Livingston County Youth Bureau; Katie Hayes-Sugarman, State University of New York, College at Geneseo; Nancy Healy, Cornell Cooperative Extension; Elizabeth Hoeve, Livingston County Youth Bureau; Nancy Horn, Blue Cross/Blue Shield; Nadene D. Hunter, M. D., Livingston County Department of Health; Susan Hurriston, M. D., University of Rochester Medical Center; Jamie Kenyon, Livingston County Rural Connections Program; Kathy Lehman, Livingston County Department of Health; Beverly Link, Livingston County Department of Health; Gregory Liptak, M. D., Livingston County Board of Health; Zora Longstreet, Help for Adolescent Parents (HAP); Wendy Love, Finger Lakes Health System Agency; Marie Mae, Livingston County Department of Health; Dan Maloney, Livingston County Sheriff Department; Leopold Marks, Livingston County Board of Supervisors; Cathie Marsh, Geneseo Central Schools; Doug Mayhle, M. D., Noyes Memorial Hospital; Dick Merges, Catholic Charities; Tim McGinnis, Geneseo Wegmans; Timothy McMahon, Catholic Charities of Livingston County; Toni Mignemi, Livingston County Department of Health; Gregory Miller, Livingston County Skilled Nursing Facilities; Keith Mitchell, Livingston County Youth Bureau/Employment and Training; Tom Moran, Livingston County District Attorney; Richard Morris, New York State Department of Agriculture and Markets; Linda Motz, Livingston County Department of Health; Cathy Muscarella, Livingston County Water and Sewer Authority; Lynn Muscarella, Mt. Morris Central School; Jennifer Norton, Livingston County Department of Health; Bob Parisen, Consumer; Dionne Parker, SUNY Geneseo Health Center; Nancy Parker; David Parrish, American Red Cross; Margy Peet, Monroe County Department of Health; Jim Peraino, Livingston County Department of Health; Charles P. Peritore, Consumer; Lucien Potenza, M. D., Livingston County Medical Society; Jac A. Ranches, New York State Department of Health; Renee Reixach, Finger Lakes Health System Agency; Diane Rogler, Noyes Memorial Hospital; Kathy Schongar, Alternatives Unlimited; Larry Schongar, Jones Chemicals; Patricia Schwegler, Livingston County Department of Social Services; Cindy Sheflin, Livingston County Department of Health; Doris Sherman, BOCES Geneseo Migrant Center; Karen Smith, Livingston County Office for the Aging; Anne Smith-Corwin, Livingston Area Transportation Service; Jennifer Sommers, Livingston County District Attorneyís Office; Abby Sparling, Adult Day Care; Mary Margaret Stallone, Livingston County Department of Health; Jean Streppa, Noyes Memorial Hospital; Debra Strollo, BOCES; Rebecca Tomalty, Monroe County Department of Health; Carol Thompson, Livingston County Department of Health; David Thorp, Cornell Cooperative Extension; Irene Turner, Geneseo Radiology; Anne Valentino, Livingston County Mental Health; Ralph Van Houten, Livingston County Department of Health; Glenda Van Ry, Resident; Kathy VanWagen, Office of the Aging; Colleen Vokes, Livingston County Department of Health; Betty Wells, M. D., Livingston County Department of Health; Norman Wetterau, M. D.; Cathie Whitney, Livingston County Department of Health; Kathe Wiener, Geneseo Central School; Anne Williams, Livingston County Department of Social Services; Nancy Winans, Medical Social Worker; Carol Woodruff, TASA; David Woods, Livingston County Planning Department; Gail Wratny-Feathers, Catholic Charities; Sandy Wright, Livingston County Department of Social Services; Michelle Young, Rape Crisis Center; and Joyce Zeh, BOCES.

The Community Health Assessment Committee was asked to identify key community leaders who needed to be invited to participate on the committee as well as in the work groups. Representatives from the various agencies asked their respective boards/agencies for additional names, and those individuals were asked to participate. Membership now includes additional insurance providers; a community hospital outside this county; and other service providers such as private mental health and Compeer, an organization that works with volunteers.

Additional potential partners who were not included in the CHA Committee or in the work groups have been identified. They have been invited to participate at this time (the CHA Committee and work groups are continuing to meet) or will be invited in the future. They include:


General consensus was the means by which the CHA Committee as well as the work groups reached a conclusion or decision.

Work groups (based on the ten health opportunities) were formed to identify resources and develop strategies to address each identified health priority. During this time Department of Health staff took the role of convenor; however, other agencies were strongly encouraged to take the leadership role. This was successful for a number of the work groups. The Chemical Dependency work group was led by the Livingston County Counseling Services and is now chaired by the Livingston County Alcoholism and Counseling Services. The Access to Health Care work group is chaired by the Finger Lakes Health Systems Agency, and the Mental Health work group is chaired by Livingston County Community Services.

Everyone is considered a valuable member and is encouraged to participate, to lead group discussions, and to present information.


Impact / Effectiveness

The expected outcome was to identify health concerns, to involve the community, and to create an atmosphere that fosters partnerships and collaborations. The success of the CHA Committee and the work groups speaks for itself. In the first year (1997), four of the ten work groups continued to meet and work toward implementing strategies to improve health. In the second year (1998), the CHA Committee identified two additional work groups to ìrevive.î Both of them have met and are working diligently toward meeting the objectives.

In addition, and most recently, the local community hospital and Department of Health have agreed to develop a joint Wellness Committee that will present community programs. In the past each agency provided wellness programs in the community, some jointly, some not. The CEO of the hospital and the public health director agreed that it would be in the best interests of the community were these agencies to join forces. Staff members have now reached out to other community agencies to join with them to create more comprehensive programs. This is a true testimony to wiping out the turf issues.

One or two of the successes (results/outcomes based on the identified interventions) from the more active work groups are described below.


Access to Health Care
This work group identified a number of issues related to access, including transportation, physician availability, insurance, and community knowledge of the available health care services. The work group is currently working with a community agency that provides hotline response (similar to Poison Control) to develop a plan for community-wide education, a resource document, and advertising in the local telephone directory as an information/referral resource. The Access to Health Care work group has linked with the Genesee Valley Health Network (rural health network) to collaborate on issues related to access to health care.


Chemical Dependency
This work group has recently decided to make two strategic moves: to join with the Community Services Chemical Dependency subcommittee and to invite the Tobacco Coalition to join forces with them in the fight against tobacco and the promotion of a county Clean Indoor Air Law. The Livingston County Council on Alcoholism has taken the lead with this work group and has developed community-based groups in four communities to address the issues involving chemical dependency among youth. Although these community groups are at different stages of development, schools, parents, and businesses have responded positively to developing a plan of action.


Exposure to Toxic and Infectious Agents
This work group has developed an active work plan that focuses on the environment. It has recommended to the CHA Committee that letters be sent in favor of a Clean Indoor Air Law and that support for funding of a public sewer system be provided to a specific community suffering from septic failures. The work group suggested that food service establishments be required to post signs for public display, explaining that bare-hand contact with ready-to-eat foods is not permissible and that violations may be reported directly to the Department of Health. The Board of Health passed such a resolution and now all restaurants are required to post the law. The work group supported efforts for radon education that helped to foster a partnership between the department and the county weatherization program to test area homes. Using New York State Department of Health minigrant funds, this collaborative effort resulted in more than 200 homes being tested over a six-month period (10/97ñ3/98).


Five Leading Screenable Causes of Death
The Department of Health is partnering with the local hospital to develop a community wellness program that will incorporate screening for several diseases. Education and screening for early detection will be a major focus. The Department of Health, in coordination with the Monroe Breast Partnership Program, provides breast and cervical cancer screening to women over 50 years of age who are either underinsured or uninsured.


Immunization
In cooperation with the New York State Department of Health, five physician offices have participated in the ìtwo-year-old record review.î Itís a pleasure to report that two of the offices had 96 percent and 95 percent compliance rates for two year olds.


Inactivity and Improper Diet
Through funding from the Healthy Heart grant, advertisements were placed in the local Pennysavers and in regional newspapers listing the hours schools were open for walking and swimming in the pools.


Teen Pregnancy
This work group existed before the CHA Committee identified teen pregnancy as a health priority. Livingston County maintains the third-lowest teen pregnancy rate in New York State; however, teen pregnancy remains a concern to the residents, schools, parents, service organizations, religious groups, and the Department of Health. Currently, a panel discussion is being planned with a local school to address the issues surrounding teen pregnancy and the interventions required. This is the first time a program of this magnitude has been presented in this community.


Violence
The Violence work group was fortunate to receive Public Health Initiatives funding for its projects. Funds through the PHI grant allowed for the purchase and development of ìpuppetî programs for the elementary grades. In the summer of 1997, the programs were presented at the summer recreational programs and were well received. With the assistance of a community physician volunteering with the Department of Health, schools are involved with tracking ìviolentî activities and working with the department to ascertain the level of violence in the schools and what impact, if any, the violence prevention educational presentations have had. The department is collaborating with a local college to assist with research on the topic of violence, using data collected through the schools. In turn, students will have the opportunity for placement with the Department of Social Services. With funding from the Public Health Initiatives grant, a community survey was conducted to obtain the opinion of the county residents on violence. This work group is aided by the involvement of the District Attorneyís Office and Criminal Justice Department, whose representatives attend meetings on a regular basis. The Criminal Justice Department revealed that county residents without financial means do not have the opportunity for legal assistance. The District Attorneyís Office and Criminal Justice Department applied for and received a grant to financially support legal assistance to those in need. Part of this grant included the development of a support group for batterers.

The activities and accomplishments listed above are only a few examples of the successful strategies implemented by the CHA Committee and work groups. The positive outcomes are that the community is receiving additional services that are better coordinated, gaps and redundancy in services are being addressed, and community agencies are working together to better meet the needs of the community. Ultimately, the CHA Committee members believe that the health of the community will be improved.

Presentations of the Community Health Assessment have been made to the following groups: Health Committee of the Board of Supervisors, Board of Supervisors, Board of Health, Livingston County Medical Society, medical staff at Nicholas Noyes Memorial Hospital, and the Chamber of Commerce. A community presentation was held and was well attended. Presentations to the above groups included comparison with the Healthy People 2000 goals and objectives as well as a ìreport cardî for the countyís health. The Community Health Assessment Report received media coverage in the local papers as well as the Rochester paper. Plans for future presentations include: elementary school principals and civic groups.

Several barriers have limited or delayed progress in the implementation of suggested interventions and strategies. While community agencies are supportive of the efforts and activities, they are reluctant to take the leadership role; hence much of the responsibility has been borne by the Department of Health. The department continues to encourage their participation and leadership and, over time, anticipates broader community involvement. Another barrier has been the lack of staff and time to incorporate the suggestionsóor even to take suggestions to another agency. Again, it is a matter of convincing others that health issues are a community concern.

Healthy communities are defined by more than the absence of disease and the prevalence of premature death. Families, employment opportunities, clean and safe environments, effective institutions (schools, faith, health, government, and business), social associations, and accountable systems (transportation, judicial, and others) all contribute to the quality of life in Livingston County. Community assets are the foundations for preventing disease and premature death. These are the same assets that preserve the advances that have occurred in health status. Healthy people grow up in healthy communities. The identification of these health priorities and risk factors is the first step in developing a plan for improving the health status of the residents. The second step is to identify resources, current efforts, and opportunities for improvement. The third, and current, step is to develop a community plan to expand existing efforts, introduce new strategies, develop and cultivate partnerships, and create an atmosphere in which these community-based activities can flourish.

The Livingston County Community Health Assessment Committee has demonstrated the principles outlined in ìCommunities Working Togetherî through its efforts to collaborate and partner with community agencies to improve the health status of Livingston County residents. The end result will be a healthier community and healthier individuals.

The Community Health Assessment Committee recently adopted a slogan that will be used with all presentations, work groups, and activities sponsored by the committee. It is: ìWorking Toward a Healthy Community.î

Contact: Joan H. Ellison, R.N., M.P.H., Public Health Director, Livingston County Department of Health, 2 Livingston County Campus, Mt. Morris, NY 14510. Telephone: (716) 243-7270. Fax: (716) 243-7287.

E-mail: hihjxe01@health.co.livingston.ny.us

See map, A10





LOURDES HOSPITAL, NORTHSIDE/EASTSIDE COALITION
BINGHAMTON




Mission/Purpose

Lourdes Hospital, as part of the Daughters of Charity National Health System, recognizes the importance of serving its community and participating in activities that match the communityís needs. The formation and participation in the Northside/Eastside Coalition is a primary example of how Lourdes has taken on a national goal to improve the lives and health status of individuals and communities, especially those who are poor and vulnerable, and implemented actions at the local health ministry to attain this goal. Subscribing to the conceptual model of ìhealthier communities,î Lourdes has used this project as a vehicle to demonstrate its concern for the total community and its social fabric, which goes well beyond the traditional model of health care delivery.

Following the establishment of Lourdes Center for Family Health, a comprehensive primary care center within the neighborhoods on the north and east sides of Binghamton, it became clear that any attempt to improve health status in the community from a purely medical model would be unsuccessful without addressing the multitude of concerns around prosperity, safety, and self-worth within the neighborhoods served. With this in mind, Lourdes recognized the need to mobilize residents, businesses, community organizations, and providers to act as agents for change. The goal: to bring the community back to a healthy, prosperous, and successful condition.

In order to initiate development of the coalition, Lourdes and St. Paulís Catholic Church took the lead in coordinating a meeting among residents and organizations with a vested interest in the community. Utilizing the model for ìhealthier communities,î the initial partners decided to follow an asset-based approach in its efforts to improve the community. The rationale behind this approach came from the recognition that a conventional needs-driven approach encourages an attitude of dependency whereby residents identify themselves as people with special needs that can only be met by outsiders. This allows them to become consumers of services, with no real incentive to be producers or problem solvers. The asset-based approach offered a more positive potential since it could lead to the development of policies and activities based on the capacities, skills, and assets of people and their neighborhoods. The approach also recognizes that significant improvements can occur only when neighborhood residents are committed to investing themselves and their resources in community building. This approach is not meant to suggest a struggling community can do without outside assistance. Rather, the approach can assure that additional outside resources will be much more effectively used if the local community is fully mobilized and invested in its own potential success.

One of the initial strategies was to identify a large number of residents and organizations with vested interests in the north and east sides of Binghamton and set the stage for a focus on their community. This strategy was meant to spike interest in the community and bring people together in a common goal to consider the future of the community. Following the initial strategy, steps were taken to match talents and assets of the community in the formation of action teams with clearly defined goals and objectives. A major focus of each team would be to set some easily attainable short-term goals in an effort to demonstrate the power and effectiveness of combining their assets in making positive change for their community. Building upon small successes, it was intended that members would move forward on their own investment and initiative to take on the major issues that had led to the decline of the community and thereby create the revitalization necessary to produce a ìhealthier community.î

Lourdesí vision of a healthy community embraces the notion that people need to be able to count on their neighbors and neighborhood resources for support and strength. The vision is one that encourages neighborhoods to set their own agendas for a healthy and supportive community. From the hospital perspective, the vision requires an understanding of the difference between managing disease and managing health. The healthy community is one that not only recognizes its problems but also takes ownership of the problems and comes together in a common goal to make positive change.


Leadership Role

Recognizing that someone needed to set the stage and begin the effort for community improvement, Lourdes stepped forward to take the lead in this project. Lourdes also enlisted the support of St. Paulís Church to cofacilitate the project since the parish is located in the target area and had direct links with residents and organizations in the neighborhoods.

Looking within the organization, Lourdes identified members of its own staff with the appropriate experience and background to initially lead and facilitate the groups that would be implemented as action teams for development of community improvement strategies. The goal was to identify vested community members who demonstrated commitment and leadership potential to eventually take over the direction of each team.

Technical assistance to the group would be provided by Lourdes and would include maintaining minutes of meetings, preparing and mailing correspondence to coalition members, providing assistance in seeking human and financial resources to implement proposed actions, and providing other support functions as needed by the coalition. Lourdes also would maintain staff on each of the task groups to maintain the liaison between the hospital and community.


Key Partners/Stakeholders

As identified in the purpose statement, the initial partners in this endeavor were Lourdes Hospital and St. Paulís Church. The real key to the entire project, however, was the immediate identification and inclusion of representatives in the community who would make up the partnership. Potential coalition participants would be individual citizens, community groups, neighborhood organizations, churches, schools, businesses, local government, and health and human service providers.

At the outset of this project, the key organizers came together in a brainstorming session to identity each of the stakeholders who would be invited to participate in the coalition. As a result of this session, over 200 individuals and organizations were identified as potential members.

To kick off the coalition effort, a large community luncheon was planned and an invitation was sent to each of the stakeholders. The invitation set the stage for stakeholders by asking them if they had taken a serious look around their neighborhood lately and noticed the changes that had occurred in the past few years. The invitation also asked them to consider their dreams for the future and whether the community was prepared to meet them.

The initial meeting was set up to discuss the purpose of forming a coalition and to create a climate of enthusiasm for bringing about positive change in the community. A variety of community indicators were reviewed at the meeting in order to set a common baseline of understanding from which a variety of work groups would begin to formulate plans.

As a framework for the discussions, members who attended the initial meetings were asked to consider some common factors in their discussions. The areas of emphasis included:

Work groups proceeded to outline for each area of emphasis community strengths, community concerns, and potential positive impact the group could make. As a result of this brainstorming session, the coalition established five task forces that would develop strategies and take responsibility for implementing actions aimed at improving the health of their community. The five task forces established were:

In an effort to assure the inclusion of additional stakeholders who may not have been identified for the initial meeting, everyone present was asked to identify anyone they thought should be included in future meetings. Additionally, both print and broadcast media covered the event in an effort to promote awareness of the coalitionís activities.

The role of Lourdes continues to be that of facilitator providing support to each of the task forces of the coalition. To maintain meaningful participation from the targeted community, leadership of the groups has been transferred to members of the community wherever possible. Also, participation has been enlisted from members of the community on specific projects implemented by the coalition. Through the inclusion of community members on short-term projects with viable outcomes, the coalition continues to assure ongoing participation on community improvement projects.


Impact/Effectiveness

A number of successful outcomes demonstrate the effectiveness of this initiative, including:

Much of the coalition activities continue to be supported by large numbers of volunteers from the community. Financial resources needed for implementation of community actions are sought from grant opportunities, contributions from area businesses, and fund-raising activities. Lourdes continues to support the activities with paid hospital staff and the recruitment of volunteers to assist on various projects.

To determine measurable effects of this project will take a number of years. With the impetus that has begun, we expect that the coalition will produce many promising long-range outcomes. In summary, Lourdes sees this as a very successful effort in fulfilling its mission to partner with the community to build a healthier future in the neighborhoods it serves.

Contact: Sister Kathleen Natwin, Vice President, Mission and Community Outreach Services, Lourdes Hospital, 169 Riverside Drive, Binghamton, NY 13905. Telephone: (607) 798-5515. Fax: (607)798-7681. E-mail: KNATWIN@Lourdes.com

See map, B13





OAK ORCHARD COMMUNITY HEALTH CENTER
BROCKPORT




Mission/Purpose

Oak Orchard Community Health Center, located in upstate New York along the southern shore of Lake Ontario, is a community/migrant health center funded by the Department of Health and Human Services. The Center provides health care to the residentsóincluding migrant and seasonal farmworkersóof three counties.

The purpose of Oak Orchard Community Health Center is to provide quality, efficient cost-effective primary health care through direct patient services, health promotion, and disease prevention. The Health Center provides family and community-oriented services with an emphasis on dignity and respect for all. These services are accessible to all people in this service area, including those who have problems obtaining health care from traditional sources due to a lack of income, transportation, or a lack of knowledge of health care available.

Philosophy/Values

This organization values and benefits from the diversity of all individuals and cultures. It is committed to educating staff, patients, and the community about the values and gifts of each person. Recognizing everyoneís contributions enables the team to offer a range of services in an environment that is respectful of the abilities, age, gender, culture, values, economic and family status, and life styles of the community it serves.

The values of the Center are: teamwork, respect, commitment, diversity, pursuit of excellence, and community oriented.


Outreach Department

The Outreach Programs are many and varied. The Migrant Health Project ties Oak Orchard to its roots as a storefront health clinic that began operating 25 years ago in an effort to serve the health needs of migrant and seasonal farmworkers. Federal funding provides medical services for migrant farmworkers and uninsured patients. Today the Center serves more than 16,000 patients in this rural tri-county community.

Migrant health care is coordinated in camps throughout the tri-county area, providing services, collaboration, and advocacy. A one-room camper is furnished as a mobile health unit and is an integral part of the program. It provides basic medical and dental care in the field for those who are unable to visit one of the two health center sites. The unit operates most evenings during the growing season to provide direct services to thousands of farmworkers each year.

The Outreach Department employs a multicultural bilingual staff that provides support services to the entire Center. Despite the seasonal nature of working with migrant and seasonal farmworkers the outreach staff is employed throughout the year. The winter months are spent planning for the coming migrant season and supporting those farmworkers, who season over.

The outreach staff serves a broad base of clients and is moving toward a case management model that employs a conceptual framework of health promotion and disease prevention. The department offers culturally competent enabling services, such as empowerment, translation, patient education, transportation, and referral.

Integrated into the Outreach Department is a Comprehensive Perinatal Care Program that follows mothers and babies in the traditional perinatal period and up to one year after delivery. The perinatal case manager provides outreach services by following up on all positive pregnancy tests, assuring prenatal care or verifying that patients are receiving care elsewhere, and offering to remove barriers to care through translation and transportation services. All outreach staff are trained to work with the perinatal population as well as migrant farmworkers.

In 1993 Rosario Rangel, the current outreach coordinator, started the Family Health Promoter (FHP) Program. Using the third-world ìpromotorasî model, migrant men and women were selected and trained to work with farmworkers to empower them through ìpopular educationî techniques similar to those used in developing countries. Promotoras are recruited from the farmworker population because of their natural leadership abilities and interest in health care. From March through May, they receive training in common health care issues, interpreting for patients, and Center health systems. From May to November, they work a minimum of ten hours per week in the Center, providing translation, outreach, transportation, case finding, and other services. It is hoped that these efforts will empower clients to assume control of their own health care and that through education, clients will experience behavioral changes and will become more adept at navigating the U.S. health care system.

Contact: Barbara Linhart, Oak Orchard Community Health Center, Inc., 300 West Avenue, Brockport, NY. Telephone: (716) 637-5319, Ext. 217. Fax: (716) 637-4990.

See map, A9





PARTNERSHIP FOR A HEALTHIER HOOSICK AREA




Mission/Purpose

The overall mission of Partnership for a Healthier Hoosick Area (PHHA) is to promote the health and well-being of the residents in the Hoosick area through outreach, education, and service coordination.

The Partnership for a Healthier Hoosick Area began through the efforts of Putnam Memorial Health Corporation, the parent company of Southwestern Vermont Medical Center, one of two hospitals serving the Hoosick community. Putnam Healthís vision is ìto make the communities we serve the healthiest in the nation,î and to that end it has dedicated 25 percent of its revenues after expenses to community health endeavors. Approximately $65,000 of this money was earmarked for the Hoosick community. A community health assessment was completed by Putnam Health, with the help of a local steering committee. This local committee then used the data from the assessment to select three issues that have the greatest impact on the communityís healthóhealth care access, youth and family problems, and substance abuse including alcohol.

The assessment was carried out in three ways. First, the key leaders of the community were interviewed and asked their opinions about the priority issues affecting health. Thirty-five people were interviewed. Next eight focus groups were held to solicit opinions from specific groupsólow income, health care providers, seniors, and youth. The last component of the assessment was an analysis of the data, such as morbidity, mortality, crime rates, dropout rates, and so on. The local steering committee reviewed the data from all three components and in a daylong retreat, through small-group and large-group discussions, chose the three priority issues and began to develop the local task forces to address each issue.

Every segment of the community was involved in the assessment process and in the prioritizing of need. The local steering committee had representation from businesses; health care and human service providers; local and county government; county departments of health, aging, mental health, social services, and youth; local clergy, all public and private schools in the community; consumers; and interested residents. Over 45 people attended the daylong retreat at which priorities and task forces were selected.

The Partnership for a Healthier Hoosick Area is currently developing its own vision of a healthy community. The subcommittee to work on this, as well as measurable outcomes for each task force or action team, has met and has determined that the PHHA will espouse a broad view of health. The roots of illness and disease will be considered when planning strategies to prevent or eliminate them.


Leadership Role

The steering committee mentioned above determined the structure for the partnership.

It emulates the Civic League model illustrated here:

Healthier Communities Council

Technical assistance was provided by Helms & Company, a consulting firm hired by Putnam Health to complete the community health assessment. The partnership is at the top, with the action teams underneath.


Key Partners/Stakeholders

The current members of the Partnership for a Healthier Hoosick Area are: Harvey Yorke, CEO, Putnam Memorial Health Corporation;

John Hayden, Furon Corporation; Phil Leonard, Consumer; Margaret O. Casey, R.N., Immaculate Conception Parish Health Program; Hoosick Area Church Association c/o Reverend Constance Ekback; Colleen Fitzpatrick, R.N., Community Health Plan; Kathleen Lacasse, CEO, Mary McClellan Hospital; Robin Chaison, Rensselaer County Department of Social Services; Vicki Ouimet, Unified Family Services; Delight Cullen, Director, Rural Rensselaer County Council; Joseph Cybulski, Unified Family Services; Marilyn Douglas, Hoosick Falls Central School; Nancy Chase, Superintendent, Hoosick Falls Central School; Sue Gurran, Rensselaer County Mental Health Department; David St. Hilaire, Supervisor, Town of Hoosick; Karen Berney, R.N., M.S., Rensselaer County Health Department; Donald Bogardus, Mayor, Village of Hoosick Falls; Valerie Sutton, Century 21 Real Estate.

These members represent a cross-section of the community, as does the action team underneath the partnership. Each action team has approximately 15 local residents working together to address the particular issue.

Potential partners not currently involved as much as desired represent the target populations we are serving, in particular, youth, low-income families, and senior citizens. These groups were interviewed in the assessment process but are not well represented on the action teams. Volunteers among seniors are currently being sought by the Rural Rensselaer County Councilís transportation project, and youth will be asked to serve on the youth task force.

As illustrated by the diagram above, the partnership is an overseeing body that sets priorities and seeks and distributes funds. It then charges already-formed local groups or newly formed groups to address the priority issues. The partnership assists these groups in seeking outside funding sources and setting measurable goals and objectives. The partnership measures performance and continually seeks appropriate representation from the targeted communities.


Impact/Effectiveness

The partnership is currently overseeing two projects: the Youth Task Force project to address youth and family needs through a Youth at Risk program, and the Rural Rensselaer County Councilís transportation program to address health care access concerns. The transportation program began in December 1997 and has provided rides to medical and other appointments as well as information and referral to needed services. The Youth Task Force has just begun its work and has hired a social worker who has made contact with several young people in need of housing, social services, and emergency food. The group is seeking a storefront rental in downtown Hoosick Falls and will be working with Hoosick Falls Central School, which recently received a grant for $48,000 to provide services to latchkey kids.

Both these and the future project addressing substance abuse will seek to measure outcomes as determined by the partnershipís outcomes subcommittee. This committee has based some of its work on the Institute of Medicineís Performance Monitoring for Community Health.

Because of the small community size and the interrelatedness of each segment of the community, each partner benefits from a healthy community. In a capitated environment, health care providers benefit when customers are healthy. Local governments and people benefit when fewer tax dollars are needed to fund public health endeavors. In the Hoosick community, families will benefit from our youth programming and the school district will pay less for special education and after-school activities.

The Partnership for a Healthier Hoosick Area is a group of volunteers without staff or official corporate status. Putnam Memorial Health Corp. provides funding and clerical support. Each action team has garnered support from other sources for its projects: the Rural Rensselaer County Council has volunteers perform office duties and has its business membersóBell Atlantic and Niagara Mohawkóprovide clerical support and mailings. The Youth Task Force has received funding from a local charitable organization, the Reynolds Foundation, and will work closely with current youth projects in the town.

The Hoosick area community is small and rural. Residents have always been active volunteers, and this project is no different. They answer phones, give rides, coach Little League, work on PTA projects, volunteer at the library. However, many longtime residents still see the community as it was in the 1950sóa thriving, industrial town with work for all and very little poverty; a place where kids didnít get in trouble, rarely ran away from home, and certainly never used drugs. Alcohol has always been acceptable to most community members, and teen drinking is ìall part of growing up.î The changes that have occurred in the town over the last 20 years are staggering. Eighteen percent of the residents are receiving Medicaid; even more are eligible. Most local industry has shut down, leaving unemployment higher than in the surrounding area. Teen pregnancies are common, and homeless teens are becoming a serious problem. The issue for Hoosick is getting longtime residents, who are willing to volunteer for many local needs, to realize that new problems exist and that everyone has to work on them together. The common response: ìWhy canít the county (school) (church) handle that?î needs to be addressed. The partnership is developing a public relations campaign to let residents know more about the group and to help them understand the problems everyone faces.

Contact: Margaret O. Casey, R.N., Director, Parish Health Services, Immaculate Conception Church, P.O. Box 269, Hoosick Falls, NY 12090. Telephone: (518) 686-5064, Ext. 208. Fax: (518) 686-1625. E-mail: Ocaseyhf@aol.com

See map, C11





POLICE DEPARTMENT OF THE CITY OF AMSTERDAM




Since Thomas Brownell took over as the city of Amsterdamís chief of police in January 1996, he has committed himself to making the community a safer place. As part of his efforts toward developing a safer community, Chief Brownell pledged to attack the cityís drug problem. In addition, he cosponsored the Do The Right Thing program and participated in St. Maryís Hospital Wellness Instituteís Partnership for Safe Communities.

Prior to Chief Brownellís installment, people were afraid to be out on the streets; they wouldnít even patronize some local businesses because of the many drug dealers in the area. However, Chief Brownellís strict drug policy quickly changed this. In 1996 drug arrests in Amsterdam were up more than 600 percent. The sight of carefree children playing on the street and the increase in patronage of local businesses are evidence of how much safer community members feel.

Chief Brownell doesnít only punish those who break the law but he also rewards those who donít. Under his leadership, the Amsterdam Police Department cosponsored the Do the Right Thing program with Catholic Charities of Montgomery County and Centro Civico of Amsterdam. The idea for the program originally came out of the Miami Police Department.

In 1990, at a Miami Police Department awards ceremony, a teenager was recognized for turning in a loaded gun he found. The young man was applauded by the more than 100 persons in attendance at the ceremony. A psychologist in the audience noticed that the young man was moved by the praise and suggested that such recognition be continuedóthe Do the Right Thing Program was born. In 1997 the Amsterdam chapter of the program was established. Every quarter since, a youth between the ages of 5 and 21 has been selected for recognition of his or her outstanding achievements.

The Do the Right Thing Program has been effective in teaching the youth of Amsterdam to be there for one another as role models and support. Furthermore, the program shows young people that they should think for themselves and not give in to peer pressure.

Under Chief Brownell the Amsterdam Police Department also joined with St. Maryís Hospital Wellness Institute to develop the Partnership for Safe Communities. The partnership views safe homes, streets, schools, and parks as the foundation of a ìsafe and enjoyableî community and its goal is to strengthen this foundation. The partnershipís mission is to:

Chief Brownell and his officers have been active participants in helping the partnership reach its goals. In order to promote the wearing of bicycle helmets, St. Maryís and the Police Department passed out McDonaldís coupons to children who were spotted wearing their helmets. The partnership also strives to promote safe driving. With the help of a grant received by St. Maryís, the department has been able to hand out brochures with seat belt information and driving tips. It uses the traffic and safety programs as opportunities to perform traffic surveys on seat belt usage and speeding.

The department also participates in the annual Family Safety Barbecue, at which state and county officers demonstrate safety techniques to residents. Drug Awareness Resistance Education (D.A.R.E.) officers attend the function as well and counsel youth on making the right decisions about drugs and alcohol.

First Nite is another community-based event that the department takes part in. First Nite is an annual event held on New Yearís Eve. Residents come together and have a good time in a nonalcoholic environment. The night includes food, bands, and shows.

Another program Chief Brownell and his staff are involved with is the Catholic Charities Domestic Violence Program, which provides training in domestic violence and intervention to officers, hospital personnel, and employees of other community organizations. Catholic Charities and the Domestic Violence Program recently presented the department with a grant that was used to remodel the departmentís training facility and to purchase new equipment.

Through the connections and partnerships heís facilitated, Chief Brownell has been a key to making the city of Amsterdam a safer and more enjoyable community.

Contact: Suzanne Hagadorn, Amsterdam Police Department, Guy Park Avenue Extension, Amsterdam, NY 12010. Telephone: (518) 842-1100. Fax: (518) 843-4987.

See map, C8





ST. JOSEPH'S HOSPITAL HEALTH CENTER'S
WELLNESS PROGRAM




Mission/Purpose

St. Josephís Hospital was the first hospital in Syracuse, New York, a community located in central New York that now encompasses approximately 500,000 individuals. St. Josephís is a tertiary care facility with a catchment area of 14 counties. The hospital is a full-service facility with maternal/child and pediatric inpatient facilities. The approximately 440-bed hospital includes a large inpatient psychiatric unit and the areaís only comprehensive emergency psychiatric program; a large outpatient mental health program; the areaís only hospital-owned certified home health agency, a licensed health agency that operates in 14 counties in central New York; the largest cardiopulmonary rehabilitative facility in the central New York area; and a maternal/child health center. In addition, the outpatient facilities include a sleep lab; a full-service clinic in a disadvantaged area of Syracuse; a satellite of that clinic in the disadvantaged area; and multiple primary care physicianís offices located in Onondaga County and contiguous counties, providing family practice care. The hospitalís cardiac surgical services are the largest in central New York. St. Josephís Cardiac Surgical Program has been rated number 1 in New York State for the last two years for which this information is available. St. Josephís Hospital operates the largest cardiac surgical program in this part of the state, with in excess of 1,000 cases per year. In addition, the cardiac catheterization laboratory is the largest and busiest in this part of the state, with over 1,300 angioplasties being performed and in excess of 3,000 cardiac catheterizations annually. The Cardiac Intervention Program is well rated within this state and participates in many national and international research investigations.

The hospital and its associated pulmonary health physicians has the largest clinical population of people with respiratory disease in the central New York area and operates a respiratory rehabilitative program in conjunction with the Cardiac Rehabilitation Program. There is also a Medicare certified Diabetic Education Program.

St. Josephís Hospital Health Center has been in the forefront of health care in the central New York area since its inception in the mid-1800s. St. Josephís Hospitalís vision is that individuals and communities will recognize that health is a lifelong process and that they need to know how to become healthy in order to maintain this optimal state. St. Josephís Hospital is attempting to meet this paradigm shift through its Wellness Programs.

The Wellness Program is the areaís only mall-based consumer health education, health promotion, and disease prevention program. The function of this program is to improve the overall health of the community by increasing consumerís knowledge of health care issues; teaching self-maintenance; promoting prevention, early detection, and intervention therapies; and providing enhanced access to health care.

The Wellness Program staff participates in health fairs; provides continuous hypertension and cardiac risk factor screenings at several locations; conducts community seminars and special screens, such as total cholesterol and pulmonary function testing; and coordinates educational programs for the community at large and specialized programming for the medical professional community.

The St. Josephís Hospital Health Centerís Wellness Programs developed from the Heart Disease Prevention Program, which started in June 1994. As such, the Wellness Programs help to provide a continuum of care through pre-hospitalization, education, and post-hospitalization support for chronic disease states. In addition, the facility provides preventive services, with a scope of care that includes the promotion of access to pregnancy prevention services and information on early childhood care and immunizations. The programs also provide information to assist clients along the health care continuum, including transplantation services, organ donation, and hospice referrals.

Since its inception, the Wellness Program has interacted with approximately 17,000 people per year through its various sites. The utilization of the malls has been particularly successful in providing:

The malls function as the ìdowntownî of this communityóas in earlier times when the physicianís office was found on main streets in small towns. These mall-based sites serve as convenient and continual reminders that health has a part in everyoneís daily activities and interests.

The establishment of these mall sites could not have occurred without the cooperation and support of the Wilmorite Company. This Rochester-based mall developer has provided space at a reduced costósometimes donating itóto St. Josephís Hospitalís Wellness Programs. For this reason, the programs are able to provide the majority of services at no cost to participants. Services offered and hours of operation have varied over the course of the programís three-year life span. Currently, the primary site for wellness programming, called The Wellness Place, is located at a suburban mall in Northern Onondaga County. This mall was specifically chosen for its large number of repeat customers and because it is the major shopping designation for not only Northern Onondaga County but also Southern Oswego County. This area represents a majority of the population that utilizes St. Josephís Hospital Health Care as its major provider. The mall site offers convenience, ample parking, safety, and accessibility. The hours of operation at the various mall sites vary according to consumer traffic. The Great Northern site is open six a days a week, with some morning and evening hours for the convenience of the customers. The satellite sites are open shorter periods of time.

Services offered at these sites are provided by registered nurses who are employees of St. Josephís Hospital Health Center. The registered nurses adhere to all New York State health screening requirements and are bound by confidentiality practices, a fact that has been appreciated and recognized by consumers who access the mall site services. The Wellness Program provides the following services: hypertension screening, cardiac risk factor screening, medication adherence counseling, and general health counseling. The Wellness Program operates the various mall walkers programs in conjunction with the Wilmorite Corporation.

In addition, there are some Worksite Wellness Programs, specifically, a supervised weight loss program that encompasses healthy lifestyle activities. This program is being utilized by mall employees.

In addition to these ongoing programs and a full source of educational materials and videotapes that are available for viewing or handout, The Wellness Place produces multiple programs that are presented periodically. These include: a series of programs entitled ìLiving Better With . . .,î which address a variety of chronic problems. The length of each series is determined by the needs of the particular clientele or the type of program being produced. The various topics include arthritis; chronic pain; diabetes management; coronary artery disease management; cancer; breast cancer considerations; menís health issues, specifically, prostate disease and colorectal cancer; and respiratory disease. These sessions vary from a four-week session on ìLiving Better With Arthritisî to a one-time program on headaches.

In addition to these types of programs, screenings are held intermittently for the general public. These include pulmonary function testing, diabetes screens, anxiety and depression screens, and cardiac risk factor/cholesterol screens (the most popular).

St. Josephís Hospital Health Center has participated in multiple partnerships with other community agencies including the Onondaga County Health Department. As part of this partnership, the hospital has utilized the 1996 New York State publication ìCommunities Working for a Healthier New Yorkî as its guide for identifying programs of worth to meet the recognized health concerns of New York State in general and Onondaga County and Oswego County in particular. The hospital has long recognized that coronary artery disease is a major source of mortality and morbidity for the central New York community. Because of the considerable preventive measures that can be taken to reduce the occurrence of this disease, it has been one of the primary focuses of all Wellness Program activities.

In addition, the co-morbidity of diabetes and cardiac disease has become increasingly evident. Therefore, diabetes management has been a cornerstone of the Wellness Program since its inception. The major focus of the entire program has been to help individuals to learn to prevent and/or manage chronic disease processes. Therefore, the concept of healthy lifestyles has also been a component of these programs since inception. Additional programming and information are available on nutrition and specific dietary concerns, exercise, stress management, smoking cessation, and self-knowledgeófor example, self-breast exams and self-testicular exams.

St. Josephís Hospital Health Center has been involved in partnerships for health with the Onondaga County Department of Health from the earliest stages of the programming. This has included serving as a site for DOH-sponsored mammographies and womenís health screens as well as the hosting of screening mammography in conjunction with Susan G. Komen Fund activities. The Wellness Place participated with the Onondaga County Health Department in a pilot program for menís health, prostate disease, and menís and womenís colorectal cancer. This pilot project resulted in approximately half of the screenings accomplished throughout New York State.

Through its Wellness Programs and health fair participation, the hospital recognized that one group of individuals that was neither being addressed nor benefiting from these programs was the group that primarily encompasses working men and women. Although it is well known that working men do not frequent shopping malls as often as working women do, societal changes also reflect that the number of working-age women who are seen routinely shopping at the malls has also decreased. For that reason, St. Josephís Hospital Health Center developed a Worksite Wellness Program. These programs will bring wellness to the work site at no charge or at low cost to the employer/employee. The Wellness Program has worked with the occupational health nurses and programs at some of the larger corporations in the area and has also provided screening services for some of the smaller employers who have no on-site occupational health. Again, confidentiality is maintained and the program adheres to all DOH screening requirements.

The Wellness Program utilizes affiliated physicians of St. Josephís Hospital Health Center and health care professionals from the hospital and from Franciscan Health Support, which is affiliated with St. Josephís Hospital Health Center. Professionals include physical therapists, respiratory therapists, dietitians, exercise physiologists, personal trainers, registered nurses, psychologists, podiatrists, nurse practitioners, and physicianís assistants. The program has also benefited from the involvement of medical social workers, occupational therapists, and patient advocates. This group has been particularly helpful with some of the support programs and some of the ìLiving Betterî programs.

The Wellness Program sites serve as a convenient meeting place for support groups such as the AICD group, the Awake group (a group of patients with sleep apnea), and others, including cancer and smoking cessation groups. The program has fostered collaboration with various recognized agencies in the community such as the American Heart Association, American Lung Association, American Cancer Society, the Arthritis Foundation, Susan G. Komen Fund, and so on.

Hypertension screenings are part of an ongoing program to increase awareness of the risks associated with high blood pressure. This program has been utilized for several reasons: (1) Hypertension is a major risk factor for multiple disease problems, (2) it is a problem that is highly responsive to lifestyle changes and/or medications, and (3) it is a chronic problem and many individuals will cease therapy without continual positive feedback. Hypertension screening (having blood pressure taken) is a function that the general public recognizes as helpful. However, most people, while they are familiar with the process, do not understand the significance of the resulting numbers. Explaining what the numbers mean is a way of starting a conversation about health risks.

The Wellness Program is currently following 1,700 individuals at the Great Northern location. These individuals have been screened within the last two years. Approximately 1,200 of them have hypertension that can be controlled by either medication or lifestyle changes. A number of these individuals were first identified as having hypertension via the Wellness Program screenings. Currently, 800 of these individuals have achieved normal blood pressure and have maintained it for at least four consecutive readings.

The Wellness Program has been utilized by physicians in the area for hypertension and cardiac risk factor monitoring. The Wellness Programís policies include referral to the primary care physician for any health concerns. Because many individuals may not always have a choice of physician due to insurance coverage, referrals are also made to physicians not affiliated with St. Josephís. When an individualís screening results indicate severe problems, the Wellness Program will refer the patient to hospital emergency departments and notify the primary care physician of the situation. The Wellness Program will call primary care physicians at the request of patients and will provide written information as to their progress or lack thereof. All participants in these programs sign a consent form indicating that they will allow this communication.

The Wellness Program continues to evolve as the needs of the communities and the services that are available change. Individuals who access the services provide continual feedback to the staff as to the type of services they receive or require and the type of programming that they feel is helpful. The program is large and multifaceted, and it would not be possible to provide all components and program descriptions here.

Promotion of the programs is accomplished through the community relations department of St. Josephís Hospital Health Center. Promotion is usually achieved through public service announcements in newspapers and on radio and television stations. However, some special programs grant enough money that paid advertising can be used. The Wellness Program accepts and actively solicits grants from appropriate health care entities and public service domains. However, the majority of the program costs are supported by St. Josephís Hospital Health Center as part of its commitment to the community. In addition, the Wellness Program is grateful for the voluntary professional services that have been donated by the aforementioned health care professionals. Without these volunteers, the program would not be able to provide the scope of services currently available to the community.

Contact: Leslie K. Holmberg, M. S., R.N., Director of Wellness and Disease Prevention, St. Josephís Hospital Health Center, 7246 Janus Park Drive, Liverpool, New York 13088. Telephone: (315) 458-3600, ext. 375.

Materials available include a brochure, a methodologies table, a copy of the focused health assessment, and a program description for work site smoking cessation.

See map B6,7





SUFFOLK'S SOUTH SHORE HEALTH PARTNERSHIP




Mission/Purpose

Suffolkís South Shore Health Partnership (SSSHP) was formed to take the health pulse of the community, gain insight into risk factors that may contribute to Suffolkís unusually high death rates from heart disease and lung and breast cancer, and develop plans to achieve measurable health improvements. A consortium was organized to achieve measurable, healthy changes in the community under the stewardship of Good Samaritan. The assessment project represents a new direction in developing health programs that are community directed (and mirrored) rather than the conventional approach where nurses and doctors spot trends and tell the hospital administrators what they should be doing.

The overall goal of Suffolkís South Shore Health Partnership is to determine the preventive and health care priorities in Islip and Bablyon Townships and to devise realistic strategies to address several of the communityís health care concerns. As it relates to the health assessment survey approach and the requisite gathering of data, the goal was to study area health needs and concernsófrom the community perspectiveówith a ìtelescope and a microscope.î

The partnershipís vision of a healthy community is one in which health and quality-of-life initiatives are undertaken that ultimately improve the health and well-being of people in local communities. These initiatives should use resources effectively and efficiently to promote health and reduce the overall cost of health care.

In June 1997 a group of 40 health and human service providers informally formed an organization known as Suffolkís South Shore Health Partnership. All came to the proverbial table willing to participate, champion the effort, and provide support. Good Samaritan Hospital Medical Center spearheaded this effort and played the role of key funding sponsor of the initiative. The initiative is a community-driven process that will result in accurately assessing and truly improving the health of the citizens of Babylon and Islip Townships. The initial partnership members have realigned as a Steering Committee in order to become more inclusive of the strengths and diversity of the other significant entities in the community.

The partnership retained the services of a professional health research and strategic planning firm to assist it in a community needs assessment.

First, secondary demographic and health data from Suffolk County was reviewed. Secondóafter thorough consultation with individual members of the partnershipóa health assessment survey was distributed to 10,000 random homes in Babylon and Islip Townships (addressed to the head of household and geo-coded to ensure representative samplings along racial, ethnic, and other demographic lines). On June 22, 1997, a widely covered press conference was held to announce the mailing of the survey. A response rate of over 11 percent was achieved, which is considered statistically valid by industry standards for community surveys by mail. Focus groups were then conducted with four populations that were under-represented in the survey returns: teens; African Americans; Latinos; and care-givers to the elderly, disabled, and chronically ill. A community forum of health providers was convened to supplement all the aforementioned data.

Utilizing the results of the health survey, focus groups, the forum, and secondary data, three areas of need were identified as priorities to be addressed in this community. They are: (1) substance abuse among teens and adults under age 30; (2) access to health care among African Americans, Latinos, seniors, and the working poor; and (3) teen pregnancy and sexual activity.

After selecting priorities, the Steering Committee met for a full-day retreat, at which time problem statements and guiding principles were composed for the task groups that would eventually undertake the mission of designing intervention strategies to address these needs. An important item on the retreat agenda was the identification of additional resources in the community to serve on task groups.

On April 27, 1998, the Steering Committee met to devise action plans for those task groups. This meeting was then followed by a Community Forum and Media Advisory on May 27, 1998, publicly announcing SSSHPís action agenda. Beginning in the summer of 1998óthrough broad community involvement on the task forcesóthe plans will then be implemented and will be measured for success over the next one to two years. New data and feedback will be accepted and incorporated into the planning effort to make the south shore a healthier community in the future.


Leadership Role

Daniel P. Walsh, president and chief executive officer of Good Samaritan Hospital Medical Center and the Board of Governors of the 425-bed Medical Center, felt that the communityóas primary stakeholders in the delivery of health careóshould have a more organized voice in the dispensation of care. Mr. Walshóin concert with the Board of Governorsófurther agreed that trends in managed care and the increased focus on preventive medicine demanded that the Medical Center take the lead on behalf of the communities it serves.

To that end, Mr. Walsh invited individuals and agencies from Babylon and Islip Townships to join together to form Suffolkís South Shore Health Partnership. More than three dozen area service providers answered that call to armsóas well as over two dozen individual residents of the community.

As a gift to the community, the Medical Center agreed to coordinate the project by providing staff support and resolved to fund the project through its initial cycle of action.


Leadership Structure

Working with Tripp, Umbach & Associatesóa Pittsburgh-based consultant and key national player in the ìHealthy Communitiesî movementóthe partnership has utilized multiple market research methods (as described above) as well as a consensus-building human resource model in which all participants have an equal say and stake in the process.

This consensus-building model is not hierarchical but rather task oriented and focused on:

The partnership has and will continue to utilize strategic planning retreats, community forums, focus groups, and participatory meetings as this process continues to unfold.

This model also embraces an adherence to guiding principles and manages itself by forming committees to aid the task groups in implementing their action plans (e.g., a funding committee to raise money, a public relations committee to build public awareness, and a program evaluation committee to access additional resources and to serve as program evaluation consultants).


Key Partners/Stakeholders

Along with the concept of the formation of a partnership came the recognition that growing a true list of collaborators was a primary order of business. Multiple resources, directories, and organizations were utilized to build a database, and these interest groups were then invited to participate.

At the partnershipís first meeting, over three dozen organizations were present, representing a host of social and health advocacy groups. Over the better part of a year, more than one dozen organizations expressed an interest and, in fact, became involved in the partnership, and over two dozen individual residents of the community joined the burgeoning group. This growth was ensured by attending to a resource database and by continually determining who else should get involved.

The partnership continues to expandóby necessityóas members have identified people and organizations integral to the disposition of partnership task groups. The partnership invited dozens of new organizations to join in this commitment to community health by requesting that they fill out a ballot. To date, over two dozen respondents have agreed to participate on a task group of their choosing.

As noted earlier, decision making is accomplished within the framework of a consensus-building model with a limited hierarchy. The partnership has elected two leaders from within its ranks to lead meetings, yet partnership members and task group participants will continue to set the agenda.

However, both Tripp, Umbach & Associates and Good Samaritan staff recognize that in order to move forward, some structure must be put into place.

Members of Suffolkís South Shore Health Partnership have formed three overarching committees to support the task forces identified earlier.

The Funding Subcommittee is anticipated to meet quarterly to coordinate the broadening of local financial resources and to facilitate the process of leveraging local funds with regional, state, and national funding sources.

The Public Relations Subcommittee will continue its efforts to raise public awareness of the process undertaken to ensure that community health initiatives have a chance to succeed.

The Program Evaluation Subcommittee will develop and access needed information resources, in addition to serving program evaluation consultants to the task groups.


Impact/Effectiveness

Because of the breadth and scope of its membership (including many of the most prominent social service programs in the area), it is expected that the partnership will ultimatelyóthrough the regular meetings and actions of the task forcesóenhance the current organizationís programs and perhaps unite similar competing organizations in the spirit of collaboration. Additionally, it was the charge of the strategic planning retreat and all subsequent task force meetings to avoid duplication of existing efforts.

Ongoing evaluation will be necessary to ascertain the partnershipís impact on the citizens of Babylon and Islip. To that end, the partnership will convene the task forces regularly (perhaps quarterly) to report on their prior and prospective actions. The partnership is expected to call its first annual meeting in May 1999 and each May thereafter. Additionally, staff of the Good Samaritan Hospital Medical Center or a partnership designee will prepare an annual report to be distributed to members, funders, service providers, and other interested parties.

The health assessment process to this point has been fully funded by Good Samaritan Hospital Medical Center as its gift to the community. SSSHP is currently seeking funds from the New York State Department of Health, Long Island Community Foundation, and the Robert Wood Johnson Foundation, among others. In addition, SSSHP will work with Tripp, Umbach & Associates to seek other state and federal grants in support of health planning and health policy advancement.

As SSSHP looks toward 1999óand if the partnership ascertains that its work on behalf of the community should expandóan attempt may be made to grow SSSHPís impact. The partnership may ask its members to donate to the extent possible. It might also increase its membership by instituting a formal sponsorship program (inviting existing and prospective donors to join the partnership). In addition, to increase grant opportunities, the partnership may move to incorporate into a 501 (c)(3) charitable organization and hire dedicated staff to manage the task forces and seek funding.

The cost to the hospital in 1997 was just over $70,000. Associated expenses include the professional mining and gathering of secondary data; the development, distribution, presentation, and summarization of the health assessment survey instrument; professional consulting services provided by Tripp, Umbach & Associates; and modest administrative expenses for collateral materials and focus group and partnership meetings.

For the calendar year 1998, Suffolkís South Shore Health Partnership anticipates expending $85,000 to support the action-oriented task forces. Income is expected to come through the solicitation efforts mentioned above and perhaps through additional funding from Good Samaritan Hospital Medical Center.

Careful and strategic communications with a variety of media outlets has served the partnership well. SSSHP received extensive coverage after announcing the community health initiative in the summer of 1997 and when it subsequently released summary data. More recently, it received noteworthy coverage at a Community Forum and Media Advisory meeting.

Additionally, the partnership expects to garner widespread support from the public and private sector. Already, local government officials have agreed to support SSSHP task groups on community-wide initiativesófor example, agreeing to assist in organizing a ìFirst Nightî on December 31, 1999, to ring in the new millennium without the use of alcohol and to aid in the pursuit of grant monies to develop a parent-teen communication program.

SSSHP expects corporations and businesses to help underwrite worthy projects for their own benefit and that of the communities in which they do business, thereby becoming part of the solution.

At the same time, it is expected that partnership efforts will be scrutinized as to their ultimate effectiveness and as a measure of true collaboration. For example, in looking at teen sexuality, the partnership must work diligently to include and bring together a family planning organization with an organization thatófor religious reasonsócannot condone birth control.

Clearly, the next steps are wrought and rife with challenges. However, the collaborative effort that has taken place for more than one year has artfully succeeded in focusing on the similarities of mission rather than the dichotomies.

Contact: Sylvia Guarino, Vice President, Marketing, Communications & Development, Good Samaritan Hospital Medical Center, 1000 Montauk Highway, West Islip, New York 11795. Telephone: (516) 376 4104. Fax: (516) 376 4107.

See map, D10





THE NORTH TONAWANDA HEALTH SUMMIT




Mission/Purpose

The mission of the North Tonawanda Health Summitóthe first such summit in the Western New York regionówas directly inspired by Healthy People 2000 and Communities Working Together to stimulate the residents served by DeGraff Memorial Hospital to take action to improve the general health of their own community and to develop strong, working partnerships to do so. The formal mission statement for the Summit was, ìTo help create a healthier North Tonawanda through discovery, dialogue, learning, and planning.î The primary goal was to achieve consensus from the community regarding both the ìindicators of needîówhat health problems existed in the view of the residentsóand how those needs should be prioritized. A further goal was to achieve broad community involvement in the initial stages so that ìcommunity buy-inî would be assured in later stages. Finally, the Summit was intended to provide the guidance (the ìroad mapî) necessary to develop and implement a community health action plan, which is now in progress.

The project was a collaborative effort between DeGraff Hospital and NTOUCH (North Tonawanda Organization Undertaking Community Health), a community-based coalition composed of representatives from North Tonawanda schools, the Niagara County Health Department, law enforcement agencies, DeGraff Hospital, city and county government, and community service clubs and agencies. Founded in 1991, NTOUCHís vision statement reads: ìWorking together, we will create a nurturing environment where every citizen can take personal responsibility of living a meaningful and healthy life.î

The initial spark for the Summit came from an American Hospital Association report, which stated that health care organizations will need to understand the importance of developing community health initiatives that improve residentsí health status. Following that report, Dr. Gary C. Brice, who was then the vice president of Community Research and Program Development at DeGraff, initiated a comprehensive review of all community health needs assessments that had been completed during the previous decade in order to develop a regional picture. That document, entitled ìPortrait of Community NeedsóAn Assessment of the Eight Counties of Western New York,î was followed over the next two years by three additional localized surveys: a community opinion survey of 848 adults residing in the Tonawanda-North Tonawanda area, a series of opinion interviews with various community leaders, and a health risk assessment of 1,510 residents conducted via phone and personal interview.

With all of this data in hand, Dr. Brice approached NTOUCH, and it was agreed that the community needed to be directly involved in putting it to use. The consensus of providers was that a community-wide ìHealth Summitî would be a far more productive forum for releasing the information and soliciting direct resident involvement than simply running a report in the local paper. NTOUCH was the ideal partner not only because of its mission but because of its network of community stakeholders at all levels.

For the planning stages, leaders throughout the community, representing a crosssection from business to clergy to politicians to residents, were recruited for feedback or involvement. The strategy for maintaining their involvement consisted of the formation of the Community Health Improvement Process (CHIP) Committee. The Commitee defined nine steps to its goal of effecting change:

The Summit became the primary strategy for effecting community-wide involvement in formulating a plan of action leading to change. As envisioned, the Summit was without precedent. It was agreed that the half-day event would consist of three main elements: small group dialogues, prioritization exercises, and brainstorming sessions. The final objective was to produce the road map mentioned above: a list of priorities accompanied by a list of actions that would lead to community-wide change of not just behavior but of attitudeóparticularly toward ìownershipî of responsibility for actingóas well.

The vision of a healthy community was ultimately identified as ìA community ëthatí implements quality of life initiatives that improve the health and well-being of its residents, uses resources effectively to promote wellness, and thereby reduces the overall cost of health care.î


Leadership Role

Much of the early leadership and planning came from Dr. Brice and colleagues at DeGraff, who then worked cooperatively with Winona Stonebraker of NTOUCH. Following the formation of the CHIP Committee and the involvement of many experienced community leaders, decisions were made by consensus. As the CHIP Committee has continued its work, several leaders have emerged, each of whom has been asked to head up a specific ìIndicator of Needî task force. Recently, DeGraff appropriately turned over the role of lead agency to NTOUCH. Currently, the primary function of the lead agency is to oversee the working Convenerís Committeeóthe group of 14 community leaders who head the task forces addressing each of the needs identified at the Summit. NTOUCH will also ensure that the community is regularly updated on the achievements of the working groups and will oversee the evaluation activities as well.

In anticipation of the Health Summit, it was agreed that a number of facilitators would be needed to assure that the objectives of the Summit were achieved and that some technical training would need to be provided. Therefore, community volunteers attended a two-hour session on how to facilitate group activity, including brainstorming, dialoging, and consensus building. Further, everyone who attended the Summit learned about ìasset-mappingîóidentifying resources (organizations) in the community that can be brought to bear on identified needs. As a result of the high level of involvement by a range of community members, a great deal of technical assistance was provided to the community. The training provided will bear directly on the communityís ability to address the identified needs successfully.


Key Partners/Stakeholders

Listed below are the groups that were involved with the planning and running of the Health Summit. Many of the members of these organizations were involved with the CHIP Committee or with working groups related to the ìContributionsî column. Many of these members have continued their involvement as part of the task forces formed for the Convenerís Committee.

All groups provided some level of assistance in one of the following areas: planning, implementation, public relations, or financial support. Groups and number of members participating included the following: NTOUCH, 20; Rotary Club of the Tonawandas, 10; North Tonawanda Mayorís Office, 5; EPIC (Effective Parenting Information for Children), 1; Niagara County Health Department, 10; DeGraff Memorial Hospital, 10; Mental Health Association of Niagara County, 10; North Tonawanda School District, 10; Western New York Health Care Association, 2; Mitchell R. Alegre & Associates, Consultants, 1; DíYouville College, 5; State University of New York at Buffalo, School of Social Work, 4.

Listed here are the names and agency affiliations of the leaders of the Convenerís Committee task forces (subcommittees). Additional information on the indicators is available in the ìReport on Findings.î Again, many of these individuals were involved in the planning stages; others are newly recruited as a result of the wide recognition of the Summitís success: Kurt Alverson, North Tonawanda Chamber of Commerce; Gary Brice, CGF Health System; Pinta Cook, Resident of North Tonawanda; Ron Dawson, North Tonawanda Mayor; Zenon Deputant, North Tonawanda Schools; Rose Marie Hall, DeGraff Memorial Hospital; Janice Hinaman, The Drug Shoppe; Dr. John George, North Tonawanda Board of Education; Dan Killian, North Tonawnada Public Library; Rev. Richard Luh, Salem United Church of Christ; Patrick McInerney, Planned Parenthood of Niagara County, Inc.; Thomas Milano, CGF Health System; Suzanne Nadon, EPIC (Effective Parenting Information for Children); Maryann Rutter, Mental Health Association; Marlin Salmon, Rotary Club of the Tonawandas; Lynn Shaftic-Averil, YWCA; John Silsby, North Tonawanda Development of Youth Recreation Programs; Winona Stonebraker, President of NTOUCH; AnnMarie Terrel, DeGraff Memorial Hospital; David Wertman, Niagara County Health Department.

In order to ensure an inclusive and representative partnership, the Summit was widely publicized in the local newspaper through news stories and flyer inserts. The newspaper also carried the health risk survey so that anyone could respond. The principle that anyone could actively participate in the work of the Summit and beyond was made explicit at every opportunity, and people were given contact names and numbers. The lead agencies at the outset, DeGraff and NTOUCH, are especially concerned with issues and methods of inclusiveness and have developed deep, active partnerships with all segments of the community. Personal contact was the primary method of recruitment of individual community leaders, and all members of the CHIP Committee were regularly asked to recommend new members, as members of the Convenerís Committee are now asked to do. Because of all of this, we are confident that no stakeholder in the community that has a significant interest in this work has been excluded.

The decision-making process of the Convenerís Committee is by consensus. As noted, members accepted responsibility for working on the indicator of need that their organization was most familiar with and for generating an action plan to address that need. Winona Stonebraker chairs the committee and facilitates the monthly meetings, but there is no hierarchical structure as such. Each member of the committee will present their action plan to the overall committee this summer, and a final report will be generated that will provide a road map for the next phase of activity. Because the selected leader has a direct and active interest in the indicator chosen, there has been steady participation and a general interest in devising a comprehensive plan. And finally, the community at large will again be updated and invited to participate in the next phase when the final report is released. Preliminary discussions have taken place regarding a follow-up Health Summit in 1999.


Impact/Effectiveness

The North Tonawanda Health Summit achieved the significant outcomes it sought: Over 160 residents from 15 to 75 years old, representing a full range of interests and abilities, were stimulated to meet for a day and come to consensus regarding the most significant challenges to the overall health and well-being of their community. The results of the Summit were gathered in a ìReport on Findings,î which gave the community its road map for further action. Measurement of the indicators of need was by common methods of statistical analysis. These indicators demonstrated that the most significant overall problem facing the North Tonawanda community in the view of its residents is the breakdown of the family, and the second most-cited problem was far behind. A Phase II actionóformation of the Convenerís Committeeówas completed, and its plan for addressing each of the indicators is forthcoming. And finally, a comprehensive picture of the assets and resources of the community, in the form of organizational and individual expertise, is more complete than it ever has been. All of these outcomes underscore the success of this project by nearly any measure.

Of mutual benefit to participants is a much clearer view of what the community most strongly believes and wants addressed, providing a mandate for action for years to come. Deeper knowledge of one anotherís work and expertise is leading to greater cooperation and, ultimately, to less duplication. The psychological benefit to the community as a whole in achieving consensus on issues of this importance is immeasurable and has certainly led to tangible action.

As a direct result of assessing the level of community concern regarding family issues, several groups and individuals were motivated to designóand have received funding from the United Way, New York State, and othersófor a Family Resource Center to be based at the North Tonawanda School District. This will directly address the need for information, support and counseling, referral, and communication throughout the community. Further, based on the success of the Summit, DeGraff Hospital and other local funders will be providing some resources and financial support to develop a more formal network of community providers and to sustain the momentum begun through this process.

Perhaps because of the small size of the community, coupled with its comparative homogeneity, there were few significant political problems encountered. Resource constraints were present but, again, not terribly significant for this phase of the overall effort. Resources (primarily funding) will become more of an issue as the Convenerís Committee seeks to implement its action plans. Some resistance had to do with organizational ìturf;î some has to do with the resistance of residents to community action such as this. However, we firmly believe that the entire process of the Summit and the work being done in its aftermath have contributed significantly to easing the resistance on both of these counts and have given this community a much different view not only of what needs to be done but how to do it.

Contact: Gary C. Brice, Ed.D., Vice President, Community Health & Wellness, CGF Health System, Inc., 901 Washington St., Buffalo, NY 14209. Telephone: (716) 843-7584. Fax: (716) 843-7494. E-mail: gbrice@bgh.edu

See map, A4




 


 
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