healthy montgomery steering committee meeting...

Healthy Montgomery Steering Committee Meeting Monday, December 8, 2014

6:00 p.m. - 8:00 p.m. Holy Cross Hospital - Germantown

19801 Observation Drive, Conference Rooms 1101 & 1102 Germantown, Maryland 20876

6:00 p.m. Welcome and Introductions Co-Chairs Councilmember George Leventhal and Sharan London

6:05 p.m. Approval of Minutes from September 8, 2014 - Action Item Co-Chairs Councilmember George Leventhal and Sharan London HMSC Membership - Update and Action Item

Welcome Dr. Joanne Roberts, Department of Recreation Proposed Charter Amendment - Action Item

6:25 p.m. HHS Director’s Comments Uma Ahluwalia

6:30 p.m. Healthy Montgomery Priority Areas and Next Steps

George Leventhal and Uma Ahluwalia

7:00 p.m. Community Health Needs Assessment Update Hospitals Update Healthy Montgomery/HHS Update

7:30 p.m. Implementation Work Group Reports

Behavioral Health Office of Legislative Oversight Study - Natalia Carrisoza Obesity Prevention Evaluation Sub-committee

7:40 p.m. State Leadership Transition

George Leventhal and Uma Ahluwalia

7:50 p.m. Open Discussion

8:00 p.m. Wrap-up/Adjourn Co-Chairs Councilmember George Leventhal and Sharan London

Next Meeting: The next Healthy Montgomery Steering Committee meeting is Monday, March 2nd, 6pm-8pm, PLACE TBD. If you would like to host a future meeting, please speak with Karen Thompkins.

HMSC Meeting 12-8-14 Handout Packet

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Healthy Montgomery Steering Committee Meeting Primary Care Coalition

8757 Georgia Avenue, 12th Floor • Silver Spring, MD 20910 Monday, September 8, 2014 ■ 6:00PM-8:00PM

Members and Alternates Present: Uma Ahluwalia, Ron Bialek, Wendy Friar, Carol Garvey, Patricia Grant, Thomas Harr, George Leventhal, Amy Lindsey, Kathy McCallum, Beatrice Miller, Nguyen Nguyen (AAHI), Cesar Palacios, Monique Sanfuentes, Ulder Tillman, Deidre Washington, Marie Wood, Sharon Zalewski and Andrew Zuckerman Healthy Montgomery Staff: Jeanine Gould-Kostka, Dourakine Rosarion, Colleen Ryan Smith and Karen Thompkins IPHI Staff: Susan DeFrancesco and Michael Rhein Guests: Eleni Antzoulatos, Natalia Carrizosa, Perry Chan, Elissa Golan, Linda Goldsholl, Sierra Jue-Leong, Linda McMillan, Patricia Rios, Heather Ross, Kevin Young and Dongyan Wei Materials distributed: Handout packet included:

1. Agenda 2. Draft Minutes from 6-9-14 HMSC Meeting 3. Resume: Marie Robey Wood 4. HM Staff Support 5. Healthy Montgomery Obesity Action Plan Quarterly Report 6. HM Obesity Prevention Partnership Report – May 29, 2014 7. Healthy Montgomery Behavioral Health Action Plan Quarterly Report 8. Healthy Montgomery Evaluation Subcommittee Quarterly Report 9. Hospital Implementation Strategies 10. HM Core Measures Set – Summary of Review and Adoption Process 11. PCC Invitation Flyer – 9/19/14 Event

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Topic/Presenter Key Points Follow-up Responsible

Person Welcome and Introductions Co-Chair: Councilmember George Leventhal

The meeting was called to order at 6:17 p.m. by Co-Chair George Leventhal with a quorum established.

Approval of Minutes George Leventhal asked the Healthy Montgomery Steering Committee (HMSC) to review the draft minutes from the June 9, 2014 meeting. • Monique Sanfuentes made a motion to approve the

minutes. The motion was seconded and the minutes were approved by voice vote.

Approved minutes will be uploaded to the Healthy Montgomery web site

Healthy Montgomery Staff

HMSC Membership Co-Chair: Councilmember George Leventhal

Councilmember Leventhal introduced HMSC member Amy Lindsey, the new representative from the Montgomery County Department of Planning and asked Ms. Lindsay to briefly introduce herself. He also announced that Marie Wood had been nominated by the Montgomery County Commission on Veterans Affairs.to represent the Commission on the HMSC. Ms. Wood introduced herself and gave a brief overview of her work on veteran’s affairs. Councilmember Leventhal asked for a motion to approve Ms. Wood as an HMSC member.

• Dr. Carol Garvey made a motion for the approval of Ms. Wood and Beatrice Miller seconded the motion. The motion passed by voice vote.

Councilmember Leventhal noted that efforts were being made to recruit a representative from the Montgomery County Commission on People with Disabilities. He also noted that the HM staff will send out notices to HMSC members who have been lax in their attendance to HMSC meetings.

Amy Lindsey and Marie Wood will be added to the HMSC Membership List Member will be recruited from the Commission on People with Disabilities; notices will be sent to HMSC

Healthy Montgomery Staff Healthy Montgomery Staff

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Person members regarding attendance.

HHS Director’s Comments Uma Ahluwalia, MCDHHS Director

Ms. Ahluwalia thanked Sharon Zalewski and the Primary Care Coalition for hosting the meeting. She announced that HM was fully staffed and introduced the newest HM Staff Member, Elissa Golan, who will join the Staff as a Program Manager on Sept. 22nd. Ms. Ahluwalia also announced that the University of Kentucky’s report on Healthy Montgomery will be published the first week of October and be made available to the HMSC members. She thanked the HMSC members for their participation in the University of Kentucky’s study of highly successful partnerships.

University of Kentucky report will be made available to HMSC members upon publication.


Meeting with Hospital CEOs Councilmember Leventhal and Uma Ahluwalia

Councilmember Leventhal and Ms. Ahluwalia reported on a meeting they had earlier in the day with the CEOs of the four hospital systems. They provided a PowerPoint presentation to the hospital CEOs about the Triple Aim. Mr. Leventhal noted that the expected new administration has a track record promoting public health and health care reform. This presents an opportunity for Maryland to make health reform a state priority and to work toward creating an integrated system of health care delivery with the expected new administration. The hospitals can be influential partners in that advocacy effort. He also mentioned that the hospital CEOs discussed behavioral health care services and their concerns about the lack of parity and lack of integration with somatic health care. They also mentioned that there has been an increase in the number of behavioral health patients and that hospital staff are increasingly at risk from violent behavioral health patients. Councilmember Leventhal reported that the group resolved to develop a white paper that will include behavioral

PowerPoint presentation to hospital CEOs will be made available to HMSC members


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Person health, Medicaid/Medicare eligibility, teen pregnancy, trauma and readmission. They will soon identify someone who can write the white paper and the resources to support the work. Discussion followed:

• Thom Harr visited a care coordination hub in Ohio, the Pathways model which is collecting valuable data;

• the white paper should include some of the work already being done in the state such as the Local Health Improvement Coalition (LHIC) grant that MCDHHS and partners received;

• mass transit, land use and planning also affect health outcomes;

• there may be a need for two different documents -- that is, a collaborative document that describes all the current work and the existing opportunities and one for the state that makes the case that it should partner with us because there is the need in the County as well as political will.

Report on white paper to be developed by hospital group.

Councilmember Leventhal, Uma Ahluwalia

HM Core Measure Selection Meeting Colleen Ryan Smith, DHHS

Colleen Ryan Smith gave an update on the HM core measure set developed by HM Data Project Team. She explained that as a result of the comments provided by HMSC members, one additional core measure was included so that there are now 37 measures. Colleen reviewed the measures as they apply to the six HM priority areas. She explained that the Data Project Team still has a few additional tasks to complete: finalize inventory of all metrics for HM; host a webinar to describe HM data; identify proxy measures for core measure set metrics not available at the County level; and identify neighborhood boundaries for running community profiles.

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Topic/Presenter Follow-up Responsible

Person Key Points Discussion followed:

• data related to the core measure set will populate much of the work on the next HM community health needs assessment; it’s important to also include qualitative data in the needs assessment to hear from community residents, police, community activists;

• unemployment has been shown to have an effect on the HM priority health issues;

• there are no additional resources to collect any additional primary data for the needs assessment, HM will be manipulating existing data; however, there is always a “wish list” of other primary data that would be helpful to obtain.

Healthy Vending Work Group Councilmember Leventhal

Councilmember Leventhal discussed the work of the County’s Healthy Vending Work Group. He described the work group membership and the group’s efforts to increase the healthy vending options available in County buildings to 50% of the options offered; the group is piloting a healthy vending effort from Oct. 1st to the end of December. Councilmember Leventhal will provide another report at the end of that period.

Report on healthy vending pilot project at the December HMSC meeting.

Councilmember Leventhal

Work Group Implementation Reports Obesity Action Plan Implementation Linda Goldsholl, Obesity Prevention Partnership Co-Chair

Linda Goldsholl summarized highlights of the obesity group’s implementation activities namely the prevention strategies that have been identified by each of the four Obesity Partnership work groups. Discussion followed:

• Dr. Zuckerman explained the difficulties involved in providing BMI data to HM that are largely due to the fact that the needed data are not computerized;

• Ron Bialek asked what success will look like in a year and Susan DeFrancesco (IPHI) explained that it is unclear how much progress each of the work groups

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Person Key Points Behavioral Health Action Plan Implementation Thom Harr, Behavioral Health Co-Chair

will make in the next year, that the work is evolving and that each of the work groups will need varying levels of support from HM staff.

Thom Harr reported that they are recruiting members for the Behavioral Health Task Force and that he and Kevin Young (Co-Chair) had been meeting with staff from the Montgomery County Office of Legislative Oversight (OLO) to discuss the contents of the OLO report on behavioral health in the County. He also reported that he and Kevin Young will be presenting about Action Plan Implementation to the Commission on Health at the Commission’s next meeting. Discussion followed:

• Natalia Carrizosa, OLO Staff explained that OLO was working closely with the BH Co-Chairs on the OLO report. She noted that the report will focus on existing gaps in the behavioral health system in the County and opportunities to close those gaps as well as consider the changing behavioral health landscape and best practices; OLO is planning to release the report by the end of the fall, in time to inform the 2016 budget requests;

• Thom Harr remarked that to make the best use of resources, the goal should be to make the behavioral health system work better, go beyond just filling gaps;

• Ron Bialek asked if the County Council had any plans to track the impact of the County’s minimum wage law because it could show an impact on health issues such as behavioral health.

Update on OLO Report at December meeting

Natalia Carrisoza, OLO

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Person Community Health Needs Assessment Uma Ahluwalia, Karen Thompkins, DHHS

Karen Thompkins briefly discussed the need to conduct a new community health needs assessment for Healthy Montgomery. She made reference to the last assessment which was conducted in 2011 and which will provide base line data. She noted that both quantitative and qualitative data will be included in the final needs assessment report and that decisions will need to be made about the content and expansiveness of the report. Ms. Ahluwalia noted that the needs assessment is an extensive exercise that will require a lot of staff resources. She also noted that it affects the decision to move forward with the DHHS accreditation process as well as the decision to move forward with additional issue areas. Discussion followed on proceeding with the needs assessment and with the remaining issue areas:

• there were concerns expressed after the last meeting by HMSC members about the way in which the decision was made to move forward with the next two issue areas – cardiovascular disease and diabetes;

• several members noted that qualitative data collection is very important – it allows for community residents to be heard

• the question was raised as to whether the HM staff can adequately support implementation, the community health needs assessment, and two new issue areas;

• several members expressed their support for moving forward with the next two issue areas, or at least one;

• the idea of slowly starting work on the next one or two issue areas was raised;

• Ms. Ahluwalia explained that action planning on the two new issue areas would be done differently and more rapidly;

Update on Healthy Montgomery Community Health Needs Assessment


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Person Key Points • Ron Bialek suggested that the HM Charter be

amended to insert language that clearly states that the HM cycle for the needs assessment is consistent with the hospitals’ three year cycle required by the IRS-he will draft language;

• Some hospital members noted that they have begun work on their most recent community health needs assessment and that their work can help facilitate the HM needs assessment;

• HM staff were requested to provide links to the hospital needs assessment and the previous HM needs assessment;

• members suggested that they each can reach out to their own networks to help facilitate data collection for the needs assessment; in particular, Amy Lindsey noted that the Department of Planning has outreach activities planned for the fall that address the intersection of health and planning – HM can use those activities as a way to collect qualitative data from the community;

• at the next meeting in December, the hospitals will be invited to provide brief (5 minute) presentations on their approach to community needs assessment and implementation;

• the MD Cost Review Commission will also be invited to the December meeting;

• Monique Sanfuentes will ask the Cost Review Commission for a helpful slide presentation;

• members were asked to consider who among them and their partners might be interested in working on the next four issue areas—at this time, no one will be recruited;

Draft of HM Charter amendment regarding timing of Community Health Needs Assessment to be discussed at December meeting Send links to HMSC members regarding previous HM needs assessment and hospital needs assessments Organize hospital presentations for December meeting Invite representative of the MD Cost Review Commission to the December meeting

Ron Bialek Healthy Montgomery staff Healthy Montgomery staff Monique Sanfuentes

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Person Key Points • at the December meeting, the members will continue

the discussion of moving forward on the remaining issue areas

Consideration of individuals/organizations to work on remaining issue areas Discussion regarding next issue areas on the December meeting agenda

HMSC Healthy Montgomery staff

Announcements/Updates Sharon Zalewski announced an upcoming Primary Care Coalition presentation, Thought to Action: Hospitals and Community Working Together to Transform Patient Care, by Kevin Sexton, President & CEO, Holy Cross Health, Sept. 26, 8-10am, at the National 4-H Conference Center - 7100 Connecticut Ave - Chevy Chase, MD 20815.

Wrap-Up/Adjourn Councilman George Leventhal

The meeting was adjourned at 8:05 p.m.

Respectfully Submitted: Dourakine Rosarion, Susan DeFrancesco and Karen Thompkins Approved: ________________________________________________

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Dr. Joanne Roberts Biography

Dr Roberts is an exercise physiologist, health promotion, and wellness professional with over 25 years of experience. She has extensive work in occupational health, wellness, fitness, and performance physiology with Montgomery County Fire and Rescue Services (MCFRS), the United States Army, United States Navy Divers, emergency services personnel, and the United States Secret Service. She has experience in designing, developing and maintaining data driven, results-oriented wellness programs that target major health risks of specific occupations. Dr. Roberts has substantial experience in health and wellness data collection, analysis, and interpretation. She compiles, analyzes, and interprets current scientific research and has done numerous presentation to both scientific and lay audiences. Dr Roberts is a specialist in exercise physiology, kinesiology, health promotion, wellness, physical activities, performance nutrition, and ergogenic aids with research experience in various aspects of exercise physiology, physical performance, and health promotion. Areas of her expertise include occupational task analysis, thermoregulation (heat and cold stress), cardiopulmonary function, metabolic function, exercise prescription, job specific training, core and functional training, exercise programs, wellness, and sports nutrition. She has extensive laboratory experience in the measurement of thermoregulatory parameters, cardiovascular parameters, body composition, muscular strength and endurance assessment, flexibility and core function. Dr Roberts has significant teaching experience in exercise physiology, health promotion, exercise science programs, train the trainer programs, and wellness and fitness activities. She is currently an Adjunct Professor in the Health Promotion Management Program at The American University, and an Adjunct Professor in the Health Enhancement, Exercise Science, and Physical Education Program at Montgomery College and she was an adjunct Professor at George Washington University School of Public Health and Health Services, Exercise Science Department for seven years. In addition to her teaching in higher education she has also has four years experience teaching physical education and health k-12 in inner city public school in Houston Texas. She was the MCFRS Exercise Physiologist and designed, developed and maintained a data driven, results-oriented wellness, fitness, and nutrition program that target major health risks of MCFRS firefighters. She also served as the MCFRS representative on the Montgomery County Wellness committee in the Health Yourself program. Dr Roberts is also a graduate of Montgomery County Manager Development Program that was a two year program to develop leadership competencies in potential County managers. Prior to coming to work for Montgomery County she was a Senior Scientist and Project Manager for Science Applications International Corporation for nine years working the area of in health and wellness with the Department of Defense. In addition she was National Research Council Resident Research Associate at Naval Medical Research Institute Hyperbaric Environmental Adaptation Program, investigating the effects of ingesting a glucose polymer solution on fluid balance and thermoregulation during prolonged exercise in cold water, and the effects of saturation diving on physical deconditioning. In support of the 1990 Gulf War, she studied the effects of pyridostigmine on divers in warm water while breathing 100 percent oxygen. Dr Roberts has authored several papers, technical reports, scientific proceedings, and congressional information papers and one book.


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Proposed Charter Amendment Language

Ron Bialek prepared an amendment to the HM Charter for Healthy Montgomery Steering Committee (HMSC) consideration and action during the 12/8/14 meeting (see Page 8 of the 9/8/14 draft minutes). Mr. Bialek’s proposed Charter Amendment would be inserted at the top of page 3 in the current Charter. The proposed language change is in italics:

Healthy Montgomery and the HMSC have a role in fostering alignment among the Healthy Montgomery member hospitals as they work to meet their community benefit requirements and address unmet health and well-being needs in their respective service areas. Collaborative efforts will result in coverage for the whole County, avoid duplicative efforts, and better allocate and leverage existing assets. To foster a coordinated approach to assessing community health needs and to assist Montgomery County hospitals in meeting their Internal Revenue Service (IRS) Community Health Needs Assessment (CHNA) requirements, Healthy Montgomery will assess health needs on a schedule consistent with the IRS CHNA requirements. Furthermore, to foster a coordinated approach to addressing priority health needs, the Healthy Montgomery member hospitals will present to the HMSC the status of their IRS required implementation strategies on an annual basis.

The approved Charter indicates “Approval of two-thirds of the membership, with a full quorum present, is required for ratification” of an amendment to the Charter. The HMSC currently has 24 members. Quorum = 50% + 1 = 12 + 1 = 13 while 2/3 x 24 = 16 members needed to approve a Charter amendment.


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MCDHHS/Healthy Montgomery Community Health Needs Assessment

Ulder J. Tillman, M.D., MPHCounty Health Officer

Chief of Public Health ServicesMontgomery County DHHS


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Purpose of a Community Health Needs Assessment

Identify the health needs of a community– Some needs are difficult to identify (depression, safety, access to healthy

food, etc.)– Sometimes community needs are not revealed until a crisis occurs---

(pedestrian accidents, Hurricane Katrina, disease outbreaks) Identify changes in the community—(social, cultural, economic)— and assess relevancy of current initiatives, programs and policiesAllow people in the community to feel they have a voice in the processStrengthen or build collaborations (e.g. fulfill MCDHHS and Healthy Montgomery missions)Develop data that will inform strategic planning and program development


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Planning/Preparation for the CHNA

Questions answered to guide CHNA process– What do we want to know and why? – Who is the assessment attempting to inform? Influence?– How will we use information? – Who should be involved? Why? – Which issues and questions are of particular interest to our

organization (DHHS, Healthy Montgomery, Partners)? – What resources are available to do the needs assessment?– What information already exists and what do we need to

gather?


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Administrative Management of the Process

Selected tools for the process and documentation– Utilizing national tools from NACCHO toolkit, validated and used by

member health agencies nationallyAdministrative process tools, survey tools, etc.Adapted to make it appropriate for Montgomery County

Reviewed 2011 Healthy Montgomery CHNATo address lessons learned To building upon efforts and successes from the first cycle

Reviewed local CHNA processes and reports to gauge processes, timeframes, investment of resources by similar agenciesAlignment with current and future agency needs (Minority Health Program and Initiatives, LIEED, Accreditation, Local Hospitals, Public/Private partnerships) Forming a team


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Workplan/Timeline

Review and analysis of Quantitative Data– Local, State, and National data related to Montgomery County– To be complete by March, 2015

Community Engagement – Qualitative Data Collection, review, and analysis

– In person and online survey of residents– Community conversations/focus groups – To be completed by May, 2015

Draft CHNA Completed by September, 2015– Present to HMSC

Completed report by December, 2015 – Incorporate CHNA into Community Health Improvement

Plan/Process


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Resources

In-kind Staff Support from DHHS (Sr. Planning Specialist, Senior Administrator, Program Manager, Senior Epidemiologist)Student interns (secondary data support, primary data collection and analysis, report writing)$25,000 from HM hospital contributions (meeting support and facilitation, survey translation, administrative)


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Next Steps

Next Steps– Finalize budget and identify additional resources– Formation of a MCDHHS CHNA committee to

help guide processMCDHHS staff - Public Health, Minority Health Initiatives and Program (MHIP), Healthy MontgomeryMCDHHS managers - Public Health and MHIP

– Secondary data review– Finalize survey and get it translated


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Healthy Montgomery Behavioral Health Action Plan Quarterly Report Submitted by Co-Chairs Thom Harr and Kevin Young

For the December 8, 2014 HMSC Meeting Inaugural Meeting of the Behavioral Health Task Force The inaugural meeting of the Healthy Montgomery Behavioral Health Task Force (BHTF) was held on November 10, 2014 at the Adventist HealthCare location in Gaithersburg. Thirty-one BHTF members attended representing a broad range of organizations from throughout Montgomery County including public and private behavioral health service providers (including mental health and substance abuse) who treat adults and children in institutional and community settings, the County’s minority health initiatives and programs, the County hospital systems, County councils and commissions, family and consumer advocates, and Montgomery County emergency services, police, and corrections. Prior to the meeting, we held several strategic planning meetings including meetings with Raymond Crowel (Chief, MCDHHS Behavioral Health and Crisis Services) and MCDHHS Director Uma Ahulwalia. We also met several times with Healthy Montgomery (HM) Staff and Adventist HealthCare (AHC) staff to plan meeting logistics and develop meeting materials including a PowerPoint overview of the Healthy Montgomery Behavioral Health work and summaries of the Healthy Montgomery Action Plan goals. A draft charter was developed to guide the work of the BHTF and clarify its scope of authority. The charter also includes a schedule of BHTF meetings for 2015 (see the draft charter attached). Also prior to the meeting, we prepared and distributed a Survey Monkey questionnaire to BHTF members. The following questions were included: How do you define behavioral health? What client population(s) are of primary interest to you? What are the top 3 things that impact the behavioral health of your clients? Where do you think more emphasis should be placed on – promotion of behavioral health, prevention or early intervention, or treatment. For what age group are behavioral health services most important? How well do you understand funding for behavioral health services Do you think the Behavioral Health Task Group should take time to study funding issues? What are your expectations for the Healthy Montgomery Behavioral Health Task Force? The survey results revealed a focus on systems comprehensiveness, prevention and wellness, early intervention, behavioral health across the lifespan, and the request for a thorough review of funding issues related to behavioral health (see a summary of the survey results attached). After a welcome and introductions and an overview of the prior Healthy Montgomery Behavioral Health work and Action Plan, participants at the November 10th meeting discussed the draft charter and the BHTF scope of authority as well as the work of the Subcommittees. Revisions based on the participants’ comments were made to the charter and participants will be asked to vote on the revised charter electronically. We also discussed the survey results with the meeting attendees. Meeting attendees signed up to be members of three Subcommittees that will work on the strategies outlined in the Behavioral Health Action Plan: (1) Enhancing infoMontgomery so that consumers, their families, providers and other social service agency or referral source personnel can easily gain clear, basic information about treatment options, the full range of available services, payment mechanisms, and how to access services; (2) Establish protocols to facilitate safe and appropriate transfer of clients from institutional settings to community behavioral health organizations, primary care organizations and crises centers; and (3) Initiate a process to explore the creation of a coordinated system of care or other formal partnership-based business agreement to meet the needs of individuals with more serious behavioral health conditions


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who live in Montgomery County. We will help schedule the first meeting of each of the Subcommittees early in the new year. Most recently, we held a meeting with HM staff and AHC staff to discuss follow-up to the November 10th meeting and to begin to plan for the Subcommittee meetings and the January meeting of the BHTF. Meeting with Montgomery County Office of Legislative Oversight Staff In our previous report, we reported meeting with Legislative Analyst Natalia Carrizosa who is preparing a Montgomery County Office of Legislative Oversight (OLO) report on behavioral health in Montgomery County. During this quarter, we held an additional meeting with Natalia and her colleague Sue Richards to provide background information and discuss issues related to behavioral health access and care in the County. We look forward to keeping in touch with Natalia and Sue as work on the report progresses. Montgomery County Commission on Health Presentation At the invitation of the Montgomery County Commission on Health (COH), we attended the Commission’s September 18th meeting. We gave an overview of the action plan report and discussed progress towards implementing the plan as well as ways in which the COH could support the implementation process. The presentation was well-received and the COH expressed support of our implementation efforts and asked that we return with an updated report at a later time.


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Healthy Montgomery Behavioral Health Task Force Charter

1. Purpose The Purpose of the Behavioral Health Task Force (BHTF) is to carry out the strategies defined in the Healthy Montgomery Behavioral Health Action Plan. That is, to:

(1) Consider ways in which infoMontgomery can be enhanced to create an accessible Web-based basic information, communications, and linkage system (e.g., infoMontgomery) through which consumers, their families, providers and other social service agency or referral source personnel can easily gain clear, basic information about treatment options, the full range of available services, payment mechanisms, and how to access services; ? (2) Establish protocols to facilitate safe and appropriate transfer of clients from institutional settings (e.g., hospitals, emergency rooms, correctional facilities, schools, universities) to community behavioral health organizations, primary care organizations and crises centers; ? (3) Initiate a process to explore the creation of a coordinated system of care or other formal partnership-based business agreement to meet the needs of individuals with more serious behavioral health conditions who live in Montgomery County. ?

The Healthy Montgomery Behavioral Health Action Plan is available at http://assets.thehcn.net/content/sites/montgomery/FINAL_Behavioral_Health_Action_Plan_Report_3_10_14_20140403085504.pdf) The BHTF will work within the framework of the Healthy Montgomery overarching goals:

• Improving access to health and social services • Achieving health equity for all residents • Enhancing the physical and social environment to support optimal health and well-being

and reduce unhealthful behaviors The recommendations of the BHTF will reflect a flexible framework based upon an agreed upon set of values so that, upon implementation, they will more readily address the needs of the ethnic and racial subpopulations in the County most vulnerable to poor health outcomes.

2. Composition The BHTF will be chaired by Kevin Young (President, Adventist Behavioral Health) and Thom Harr (Executive Director, Family Services, Inc. and Healthy Montgomery Steering Committee member). BHTF membership includes public and private behavioral health service providers (including mental health and substance abuse) from throughout Montgomery County who treat adults and children in institutional and community settings. Also represented are the County’s minority health initiatives and programs, the four County hospital systems, County councils and commissions, academia, family and consumer advocates, and Montgomery County emergency services, police, and corrections.

3. Scope of Authority, Structure, and Member Responsibilities BHTF Scope of Authority. The BHTF will make recommendations to the Healthy Montgomery Steering Committee on needed programs, policies, and funding related to the Strategies listed


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http://assets.thehcn.net/content/sites/montgomery/FINAL_Behavioral_Health_Action_Plan_Report_3_10_14_20140403085504.pdf

http://assets.thehcn.net/content/sites/montgomery/FINAL_Behavioral_Health_Action_Plan_Report_3_10_14_20140403085504.pdf

DRAFT 12-2-14

above. BHTF Co-Chairs will meet with the Healthy Montgomery Steering Committee (HMSC) twice per year to receive a response to and discuss the BHTF recommendations. BHTF Co-Chairs. The BHTF Co-Chairs will guide the work of the BHTF and its Subcommittees. They will call and facilitate BHTF meetings and set the meeting agenda. BHTF Co-Chairs will submit and present a quarterly report to the Healthy Montgomery Steering Committee (HMSC) and will monitor Subcommittee progress and finalize BHTF deliverables for submission and presentation to the HMSC. BHTF Co-Chairs will serve for a one year term with the ability to serve up to three years consecutively. BHTF Subcommittees. The BHTF will create Subcommittees in order to accomplish its work. Each Subcommittee will focus on one of the three strategies of the Behavioral Health Action Plan. BHTF members will select a Subcommittee on which to serve. BHTF Subcommittee members will attend meetings and contribute their expertise, knowledge, resources and time to help accomplish the Subcommittee’s work on its respective deliverables. Subcommittee Chairs. Subcommittee Chairs will be elected/decided by the Subcommittee members. The Chair will: 1- schedule and arrange Subcommittee meetings and develop an agenda; 2- facilitate the meeting; 3- ensure that meeting notes are taken and sent to a designated Healthy Montgomery staff member; 4- communicate with members as necessary and otherwise advance the group’s work in between meetings and 5--complete a quarterly report template provided by Healthy Montgomery (HM) staff to report on Subcommittee progress and activities. The Subcommittee Chair will report subcommittee progress and activities to the BHTF Co-Chairs. Subcommittee Chairs will serve for a one year term with the ability to serve up to three years consecutively.

4. Staffing and Resources Adventist Behavioral Health (ABH) Staff and Healthy Montgomery (HM) staff will work with the BHTF Co-Chairs on setting the agenda for meetings of the full BHTF and assist with meeting logistics for those meetings. ABH Staff and HM Staff will also assist the BHTF Co-Chairs with the monitoring of the Subcommittee work. The HM staff will provide quarterly report templates to the BHTF for completion by the Subcommittee Chairs. HM Staff will also inform the BHTF Co-Chairs and Subcommittee Chairs and Co-Chairs of upcoming deadlines and target dates for deliverables. HM staff will assist the BHTF Co-Chairs with the preparation of their quarterly report to the HMSC and with finalizing and preparing BHTF deliverables. HM Staff and the Healthy Montgomery Steering Committee Evaluation Subcommittee will assist with developing an evaluation plan for the BHTF work.

5. Meetings BHTF Meeting Schedule. Meetings of the BHTF will occur according to the following schedule: November 2014 (the inaugural meeting), January 2015 (at this meeting, BHTF members will review the State draft budget and develop an advocacy platform), March 2015 (at this meeting, BHTF members will review the Montgomery County Office of Legislative Oversight Report on Behavioral Health and the Montgomery County draft budget and develop an advocacy platform),


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DRAFT 12-2-14

June 2015 (at this meeting, BHTF members will review the progress of the Subcommittee work ), September 2015 (BHTF members will discuss and finalize recommendations for presentation to the HMSC), October 2015 (recommendations will be submitted to the HMSC for implementation in 2016). Webinar conferencing capabilities will be available, when needed, to facilitate member attendance. BHTF Subcommittee Meetings. Meetings of the BHTF Subcommittees will be scheduled by the Subcommittee Chairs (in person or via teleconference) as needed to accomplish the Subcommittee work.


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Healthy Montgomery Behavioral Health Task Force

InfoMontgomery Subcommittee

Susan Augusty, Montgomery County Collaboration Council for Children, Youth and Families Perry Chan, Asian American Health Initiative, Raymond Crowel, Behavioral Health and Crisis Services, MC Department of Health and Human Services Patricia Rivas, Identity Inc. Shane Rock, Interfaith Works Stephanie Rosen, NAMI Montgomery County Robert Tobin, EMS Section, MC Fire and Rescue Services

Protocol Subcommittee Jamie Baltrotsky, EMS Section, MC Fire and Rescue Services Brian Bartels, Psychological Services, Montgomery County Public Schools Lauren Campbell, MC Correctional Facility Barrie Friedm omery an, Cornerstone MontgMary Joseph, Primary Care Coalition Stefan LoBuglio, Pre-Release and Reentry Services, MC Department of Correction and Rehabilitation Sharon MacDougall, Consumer Advocate Eugene Morris, Behavioral Health and Crisis Services, MC Department of Health and Human Services Jennifer Pauk, M gram, Primary Care Coalition ontgomery Cares Behavioral Health ProRoberta Rinke Children and Youth r, MC Commission onArleen Rogan, Family Services, Inc. Angela Talley, MC Departmen tation t of Correction and RehabiliRobert Tobin, EMS Section, MC Fire and Rescue Services


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Healthy Montgomery Behavioral Health Task Force

Coordinated Care Subcommittee

Elmore Briggs Advisory Council , MC Alcohol and Other Drug AbuseTeresa Chapa, Latino Health Steering Committee Raymond Crowel, Behavioral Health and Crisis Services, MC Department of Health and Human Services

Larry Epp, Family Services, Inc. Thom Harr, Family Services, Inc. Hope Hill, MC or Children, Youth and Families Collaboration Council fMary Joseph, Primary Care Coalition Sharon MacDougall, Consumer Advocate Elizabeth McGlyn Council n, Suburban Hospital Community Benefit AdvisoryStefanie Moren ociation of Montgomery County o, Mental Health AssCarey Riordan , Holy Cross HospitalArleen Rogan, Family Services, Inc. Celia Serkin, MC ommittee Mental Health Advisory CRevathi Vihran, MC Commission on Aging Meghan Westwood, Maryland Treatment Centers, Inc. 11-10-14


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Behavioral Health Task ForceSurvey Monkey Results


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Q1: How do you define Behavioral Health?Answered: 20 Skipped: 1

Behavioral health is a term that covers the full range of mental and emotional well-being – from the basics of how we cope with day-to-day challenges of life, to the treatment of mental health and substance abuse disorders. It includes both mental health and substance use and encompasses a continuum of prevention, intervention, treatment, and recovery support services. On an individual level, it can be defined as how a person thinks, feels and acts when faced with life’s situations. It is how people see themselves, their lives and the other people in their lives. It is how they evaluate their challenges and problems, and explore choices.Area of mental health and addictions Is how a person thinks, feels and acts when faced with life situations. Behavioral health refers to cognitive-emotional-behavioral (mental health) well-being, to include substance abuse/addiction.behavioral and emotional health that affects wellness. Subsets include mental health and substance abuseSubstance abuse, mental health including personality disorders Behavioral health includes not only ways of promoting well-being by preventing or intervening in mental illness such as depression or anxiety, but also has as an aim preventing or intervening in substance abuse or other addictions.The provision of health care from a whole person perspective. Behavioral health is defined by someone's emotional and mental wellness. I define it as habits or attitudes of individuals that have an impact on their health. These attitudes can be determined by the cultural, social educational and environmental backgrounds of the individual.Mental Health and everything attached to this. The health and stability of our mental well being. Mental health as it relates to behavior. Integrated care including mental health and substance use/abuse.A state of psychological well-being and mental health characterized by the ability to cope with normal life stresses, resilience in response to stress, a sense of subjective well-being, and the absence of mental disorderserious mental health and/or substance abuse problems that affect one's family and/or occupational functioning and cause significant distress.The connection between people's behavior and their physical and mental health. Behavioral health is the ability to cope with life on a daily basis. Mental illness and substance abuse are issues that relate to the brain that can compromise that ability.Your mental well being which includes physical health and substance use disorder The comprehensive treatment of mind, body and spirit to achieve a fully functional and meaningful life.


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Q2: What client population(s) are of primary interest to you? List in priority order if there are multiple answers.Answered: 21 Skipped:0

Families raising children with emotional, behavioral, mental health, and/or substance abuse challenges 2. transition-age youth and youth adults with emotional, behavioral, mental health, and/or substance abuse challenges 3. grandparents raising children whose parents have emotional, behavioral, mental health, and/or substance abuse challenges 4. seniors with emotional, behavioral, mental health, and/or substance abuse challengesAdults ages 18-70, including transition-age youth, if they are at least 18. Individuals who have mental health challenges only or mental health and substance use issuesAdolescent children ParentsThe seriously mentally ill adult population who are subject to incarceration. 1) Immigrant populations 2) Chronically exposed to trauma Persons with substance use disorders and co-occurring disorders corrections, homeless, poor, remainderuninsured or underinsured population populations with problems accessing and receiving services: language and/or stigmaSubstance/mental health disorders. youth through seniors SENIOR CITIZENS. Children and young adults. Adolescents Children FamiliesChildren & Adolescence Adult Geriatric Adolescent Individuals with serious and persistent mental illness with or without co occurring substance use/abuse concerns. Children and youth betweeen birth and young adulthood 1. People with low income and major BH problems 2. Individuals in crisis for whom brief effective intervention would forestall major problems for them and their families 3. Children for whom comprehensive social and behavioral services would impact on their ability to have satisfying, contributing adult lives.Young adolescent girls At-risk youth Underserved youth Children and adolescents with varying issues, adults with serious mental illness. people living with a mental health diagnosis Children and Youth


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Q3: What are the top 3 things that impact on the behavioral health of your clients?Answered: 20 Skipped:1

lack of access to a comprehensive range of services and supports that are affordable and accessible, including psychiatric and therapeutic interventions, care coordination, wraparound, and peer support 2. stigma and criminalization of those with emotional, behavioral, mental health, and/or substance abuse challenges and blaming the consumers and their families 3. health disparities, the culture of poverty, linguistic and cultural competency, and family and consumer partnership with providers and agency representatives 1. Lack of affordable housing 2. Lack of general case management 3. Transportation Family issues, self esteem and abuse Medication non-complaince Need for long term case management services Lack of psychiatric hospital bed availability1. Access to resources 2. integration and coordination of care between service providers and consumers 3. Supportive systems of community based resources (i.e. affordable housing, etc) 1. In CJ system, discontinuity of treatment as individuals move within and outside of CJ/HHS system 2. Different treatment philosophies and medication protocols of psychiatrists within CJ and HHS systems and no processes to reconcile/collaborate for good of patients. 3. No physical medical center/clinic for them to return to in thecommunity and difference between state and county policies.1. Integration of services: whether they can have their behavioral health and medical needs met in the same location 2. Socio-economic factors - poverty, literacy, domestic violence, language, legal status 3. Stigma – which prevents clients from seeking BH services in traditional settings Mental health Physical healthpoverty, homelessness and life stressorsMental health for example, MCI and dementia, and addictions. Isolation and poor social connections Poor over all health Trauma Substance Abuse Untreated/Undiagnosed behavior heath concernsPoverty, minimal resources available, non-complianceSubstance use Poverty Medication non compliance 1. Chronic poverty 2. Insecure Housing 3. Access to substance use/abuse treatment A combination of biological, social, and environmental factors and lack of access to effective mental health information and treatment

Poverty high cost of housing lack of services for undocumented individuals Socioeconomic status Self-esteem/Confidence environmentTruama, general stress, and brain chemistry. following a treatment plan physical health housing/jobPoverty Immigration Status Affordable Housing


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Q4: Where do you think more emphasis should be placed on?Answered: 21 Skipped: 0


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Q5: For what age group are behavioral health services most important?Answered: 21 Skipped: 0


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Q6: How well do you understand funding for behavioral health services (federal, state, local, private)?Answered: 21 Skipped: 0


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Q7: Based on your answer to Question 6, do you think the Behavioral Health Task Group should take time to study funding issues?Answered: 21 Skipped: 0


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Q8: What are your expectations for the Healthy Montgomery Behavioral Health Task Force?Answered: 20 Skipped: 1

1. To advance and monitor the implementation of the Action Plan's three recommendations to improve the overall behavioral health (including mental health and substance abuse) of County residents: • Expand the existing infoMontgomery website to make it easier to understand and access basic information about behavioral health treatment services and payment mechanisms. • Improve communication among behavioral health service providersin order to create effective linkages (warm hand-offs) for individuals with behavioral health diagnoses as they move between behavioral health service providers and between levels of care. • Explore the creation of a coordinated system of behavioral health and health care services in Montgomery County. 2. To serve as a focus of accountability 3. To identify barriers to implementation and come up with possible ways to address them 4. To ensure that diverse family and consumer voices are included in the implementation efforts as genuine partners in the change process I would like to see the task force listen to and include primary consumers' issues, needs, etc. This would include the importance of recovery, the effectiveness of peer support and the Wellness Recovery Action Plan (WRAP). After reading the documents I found on the web, I did not see evidence of primary consumer involvement in the planning process (there might have been, but it wasn't apparent.) For example, one thing I noticed when I lookedat the graphic with all of the words that I assume, represented what the task force was focusing on, etc.,was that the words "recovery", "peer support" and "WRAP".where not represented anywhere in that graphic.. There is a famous saying in the recovery movement, that was made by Judy Chamberlain,: "Nothing about us, without us". I think that sums it up, nicely. I am very pleased and grateful that I have been invited to join the task force to share the consumer perspective.. . To raise awareness about how behavioral health laws influence health improvement. Implementation of the three identified health issue areas with follow up assessments as to impact after the planned 3-5 years.Identify areas to impact coordination of services and increasing resources in the community Addressing long-standing problems with continuity of care in MH system both within and outside of correctional systems.I expect the task force to produce clear, logical, actionable ideas (free of consultese) that will lead to real and measurable improvements and changes in services for the most needy and vulnerable populations. I expect the task force to consider the Triple Aim when developing these goals: 1) Improving the patient experience of care (including quality and satisfaction); 2) Improving the health of populations; and 3) Reducing the per capita cost ofhealth care. To offer solutions, to the county, for improved behavioral health care.Ensure a coordinated effort of all service providers to advocate for more resources/funding/services for behavioral health services and that all providers coordinate service provision across all sectors better. Recommendations to the County of behavioral changes that are evidence based for the County to implement. To improve the behavior health of residents of Montgomery county through comprehensive services. Continued


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Q8: What are your expectations for the Healthy Montgomery Behavioral Health Task Force?Continued:

To collaborate resources on how to better serve one of our most vunerable populations. We would also like to incorporate some type of program into Fire & Rescue as we are in their homes and have a good idea of how they are being cared for. Identify mental health needs in the community and improve service delivery Identifying Federal and State resources as well as County specific concerns that may be County funded. Action-able recommendations that will lead to greater awareness of, and access to, affordable mental health information and services.Find collaborative ways to fill gaps in services for individuals with significant mental health services. This is usually not a problem of needing "more funding" or "more services" for outpatient services, but is rather about a poorly coordinated system, lack of willingness to fund certain adjunctive services such as housing, and a willingness to scapegoat individuals who have fallen afoul of the criminal justice system justifying not offering services that would make a difference in turning their lives around. I hope to contribute the need for early intervention with young adolescents. I am interested to learn more about how the task force is going to work within the County to provide both prevention and intervention. Its a massive undertaking. I hope that the task group can get current resources to be coordinated and identify gaps. Gaps should include not just services but how services are funded and how that impacts on the ability to assist people in need. to layout points of access for Montgomery County Residents to receive behavioral health treatmentTo integrate the system of care by facilitating cross-agency communication and collaboration and thereby close the many holes in our frayed safety net.


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Healthy Montgomery Obesity Action Plan Quarterly Report Submitted by Co-Chairs Linda Ashburn and Linda Goldsholl

for December 8, 2014 HMSC Meeting

1. Obesity Prevention Partnership New Name, Vision, Mission and Goals. At their monthly meeting in November, Partnership members approved a new name for the Obesity Partnership: Eat Well, Be Active: A Healthy Montgomery Partnership. They also approved a revised Vision, Mission and Overarching Goals. Partnership Coordinating Committee and HM staff worked with and incorporated comments offered by participants at the May 29th inaugural meeting to develop the revised versions. Please see a new Partnership fact sheet attached, prepared by Elissa Golan of HM staff, that includes the revised vision, mission etc. Work Group Meetings: Four work groups of the Obesity Prevention Partnership: child care/home, health care, school, community environment – have been meeting monthly since September. They meet in one large, common room at the Long Branch Community Center on the third Wed. of the month, 2:30-4:30pm. The groups are at different stages of forming their action strategies:

• School Work Group – The work group’s goal is to assist with the formation and functioning of wellness councils at three elementary schools in the Long Branch area – Rolling Terrace, Broad Acres and New Hampshire Estates. The councils will coordinate and promote activities within the schools related to healthy eating and increased physical activity. The work group has collected many existing resources about school wellness councils, some specific to Maryland, and has been in touch with DHMH staff working on the promotion of school wellness councils in local schools. By January 2015, the work group will work to have logistics in place for a first meeting of a school wellness council at Rolling Terrace Elementary School that will be held in February. They will also have invited key stakeholders to this first meeting (including school administration, parents, teachers, counselors, Linkages to Learning staff, students, and school nurse). Challenges: engaging strategic partners at the schools; finding funds for refreshments to encourage attendance at wellness council meetings.

• Community Work Group – The work group, in collaboration with HM staff, has been creating an asset map of obesity prevention and reduction-related resources in the Long Branch area (using existing lists of resources from CHEER, the Montgomery County Food Council, and infoMontgomery). They have narrowed down focus areas to include: Physical Activity, Healthy Eating, Nutrition Education, and Nutrition Counseling, and are exploring how best to work within the infoMontgomery infrastructure. They will develop ways to share the asset map information with service providers, nonprofit organizations, residents and others in the community to highlight existing community assets for increased utilization by residents. By January, 2015 the work group will have verified the existence and accuracy of each community resource within the 4 focus areas and populated them in infoMontgomery. The group will be soliciting


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feedback from Long Branch partners at a Dec. 4th meeting hosted by Impact Silver Spring. Challenges: keeping asset map information up-to-date; measuring impact of asset map distribution; literacy limitations.

• Child Care/Home Work Group – The work group is currently looking into the feasibility of promoting the 5-2-1-0 campaign (a public education campaign to bring awareness to daily recommendations for nutrition and physical activity) among partners in the Long Branch community, with a focus on children under 5 years old and with a strong breastfeeding component. The group is currently investigating the evidence-base for the campaign. By January 2015, the group will have selected its materials for the campaign. Challenges: narrowing down all the information available; reaching unlicensed childcare providers; finding funds to purchase promotional materials.

• Health Care Work Group – The work group has reviewed obesity screening toolkits for providers. The group’s goal is to offer providers in Long Branch an easy-to-use screening tool to identify patients at risk for obesity and provide patients with information about available community resources (using community group’s asset map) and educational materials. By January 2015, the work group will have identified physical activity screening questions that, when combined with BMI status, alert providers that intervention is required. Challenges: promoting use of screening tools beyond partnership organizations; strategy to make any materials available to those interested.

University of MD and Other Interns – In order to offer more support for the research and administrative needs of the work groups, Linda Ashburn has provided the assistance of undergraduate University of Maryland interns. The obesity co-chairs and HM staff provided an orientation for the interns. They are in touch with the work group leaders and have begun to provide research support to the work groups. They are also helping to maintain Dropbox folders that have been set up by HM staff for each work group. Linda Ashburn also identified an intern who works with CCI’s WIC program. The WIC intern is working with the University of MD interns to support the health care work group and is helping facilitate the group’s work. An intern from the DHHS Office of Community Affairs has also joined the community work group and has offered assistance to that group. Additional Planning/Evaluation Support for the Work Groups. New HM staff person Elissa Golan, who is skilled and experienced in planning and evaluation, has begun to provide planning support to the obesity work groups as they identify strategies/ interventions in the Long Branch community by having the groups identify: (1) need/ gap addressed; (2) evidence base; (3) specific target audiences reached; (4) intended results; (5) major activities and deliverables; and (6) resources needed. This effort will assist in developing evaluation plans for the proposed strategies/ interventions. Coordinating Committee: The Partnership’s Coordinating Committee met during this quarter. The members worked on revisions to the Partnership name, vision, mission and overarching goals for adoption by the larger group; discussed how best to introduce evaluation and HM staff assistance regarding evaluation to the work groups; and began to


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discuss the elements of a sustainability strategy. A meeting is scheduled for Dec. 8th with newly hired contractor GeMar Neloms who will assist the Coordinating Committee with developing a sustainability/funding strategy. GeMar is funded as part of the LHIC grant awarded by the Maryland Community Health Resources Commission to support obesity prevention efforts and has 2 primary tasks over the next few months that she will work on with the Coordinating Committee: (1) Develop a sustainable funding strategy to support collaborative efforts in Montgomery County through Eat Well Be Active, including identifying a supporting individual or agency. (2) Create and publicize an obesity-related website with links to county, state and national public and private agencies addressing obesity prevention and reduction.

2. Data Monitoring and Surveillance System

This update will be finalized and provided at the meeting.


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The Montgomery County Community Health Improvement Process (CHIP)

What is Eat Well, Be Active?

Eat Well, Be Active is a county-wide Healthy Montgomery partnership launched in May 2014 following the release of the Healthy Montgomery Obesity Action Plan. The purpose of the partnership is to create and implement a coordinated strategy to decrease obesity in Montgomery County. Partnership members include community members, local non-profit and service providers, health care providers, representatives from Montgomery County government agencies and public schools, County hospitals, academic institutions, and insurance payers. Vision A community where eating healthy and being active are routine and easy choices for all who live, work, play and learn in Montgomery County. Mission To promote health equity by increasing opportunities for all Montgomery county residents to lead healthy, active lives. We do this by rallying community resources and by using and evaluating strategies that work to support healthy eating and active lifestyles. Goals Our overarching goals for where we live, work, play, and learn in Montgomery County are to:

• Increase active living options and opportunities to make them routine. • Improve access to healthy foods and beverages to make them routine, easy choices. • Disseminate socially and culturally appropriate messages that promote active living and healthy eating. • Increase collaboration and coordination of resources across public and private sectors to promote active

living and healthy eating. Approach Eat Well, Be Active’s approach is to focus on limited-income families with children and on prevention, starting with selected communities considered to be at high risk for obesity in order to pilot intervention efforts. The pilot community of Long Branch/ Takoma Park was identified based on the following:

• High FARMs rates in 3 elementary schools (Broad Acres ES 94.3%, New Hampshire Estates ES 93.5%; Rolling Terrace ES 68.1%).

• Applied to become a Health Enterprise Zone based on poverty and lack of access to healthcare services. • Presence of numerous community-based public and private-sector efforts to improve the health and

well-being in Long Branch/ Takoma Park and interest among these groups in Healthy Montgomery efforts.

Elementary schools are a focus, as these are in communities with families with young children. High FARMs rates are a proxy for food insecurity, which is associated with higher risk of obesity among mothers of food-insecure families1. There is also documented success in King County, Washington, where prevention efforts were implemented in communities surrounding schools with high FARMs rates. A decrease in the prevalence of obesity in these intervention communities has been documented.2 A place-based strategy was also developed based on recommendations from Robert Wood Johnson Foundation and Institute of Medicine.


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http://assets.thehcn.net/content/sites/montgomery/FINAL_Obesity_Action_Plan_Report_3_10_14_20140328130842.pdf

The Montgomery County Community Health Improvement Process (CHIP)

Current Activities Eat Well, Be Active’s strategy is to approach residents where they live, work, learn and play. Based on this strategy, Partnership members have divided into the following groups to develop strategies to reduce and prevent obesity in the Long Branch/ Takoma Park community:

• School • Community • Health care • Home/ child care

Coordinating Committee Eat Well, Be Active’s Coordinating Committee monitors and guides the Partnership’s work and is also charged with developing a funding strategy, communication strategy, and working with the Healthy Montgomery Steering Committee’s Evaluation Subcommittee on an evaluation plan. The committee will also address ongoing data needs of the Partnership. Members include:

• Linda Ashburn, Chair, University of Maryland Extension • Linda Goldsholl, Chair, African American Health Program, Montgomery County Department of Health

and Human Services • Bruce Baker, Community Health and Empowerment through Education and Research (CHEER) • Tanya Edelin, Kaiser Permanente • Marisol Ortiz, Primary Care Coalition • Dr. John Torontow, Community Clinic, Inc.

References 1Larson, N and Story, M (2010). Food Insecurity and Risk for Obesity Among Children and Families: Is There a Relationship? Minneapolis, MN: Robert Wood Johnson Foundation, Healthy Eating Research. Available at http://www.rwjf.org/files/research/herfoodinsecurity20100504.pdf. 2Kern, E; Chan, NL; Fleming, DW; and Krieger, JW. Declines in Obesity Prevalence Associated with a Prevention Initiative – King County, Washington, 2012. Centers for Disease Control and Prevention, MMWR Weekly Report. Vol. 63/No.7, February 21, 2014.

For more information, visit www.healthymontgomery.org Follow us on Twitter @hlthymontgomery Email us at: [email protected]


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http://extension.umd.edu/

http://www.onehealthylife.org/

http://www.onehealthylife.org/

http://communitycheer.org/

http://thrive.kaiserpermanente.org/care-near-mid-atlantic

http://www.primarycarecoalition.org/

http://www.cciweb.org/

http://www.rwjf.org/files/research/herfoodinsecurity20100504.pdf

http://www.healthymontgomery.org/

Healthy Montgomery Evaluation Subcommittee Quarterly Report

Summary of Activities The Evaluation Subcommittee met on September 19 and November 10, 2014 to begin determining an approach to its work. The following are highlights from those meetings, as well as a listing of additional Subcommittee activities.

Meeting Highlights: • September: The subcommittee began with a discussion about the role of evaluation in

community health improvement activities, informed by some research conducted by one of Mike Stoto’s Georgetown students. The Subcommittee resolved to meet monthly for the time being, pointed out the need to pose basic evaluation questions to the obesity work groups (why will this work, is it actionable, how will we measure it, what data is available or can be collected to measure it?), and emphasized that the work groups need to use evidence-based strategies.

• November: Discussion focused on the need to clarify the role and scope of the Evaluation Subcommittee, and to obtain feedback from the HMSC to address this. As a result, the Subcommittee has developed a draft charter for the HMSC’s review and discussion.

Subcommittee Activities:

• HM staff worked with Subcommittee members to develop draft charter language. Subcommittee members provided input via an online survey, conference call, and email.

• Mike Stoto (affiliation: Georgetown University) and Dawn Valentine (affiliation: African American Health Program) volunteered to serve as the Subcommittee co-chairs.

• The Subcommittee is working on an obesity logic model as part of efforts to develop evaluation approaches to the implementation work.

• HM staff is working with obesity partnership work groups to have them address program planning components (need, target audience, evidence base, goals/ objectives, activities, deliverables, resources)

Draft Charter: Questions for HMSC The Measurement and Evaluation Subcommittee has submitted for review and discussion a draft charter (see attached) that outlines the Subcommittee’s potential purpose, role, and scope. Questions for the HMSC include:

• Does the proposed charter language capture the intended purpose, role, and scope of the Subcommittee?

• Does the Subcommittee have the resources needed to provide the advisory support described in the charter, particularly as the number of Healthy Montgomery priority areas expand?


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DRAFT Healthy Montgomery Measurement and Evaluation Subcommittee Charter

1. Purpose The purpose of the Measurement and Evaluation Subcommittee is to support the Healthy Montgomery Steering Committee (HMSC) related to Healthy Montgomery measurement and evaluation activities, and to work with Healthy Montgomery staff to identify measurement and evaluation approaches for Healthy Montgomery action planning, implementation, and related Triple AIM activities.

2. Composition The Measurement and Evaluation Subcommittee includes members of the HMSC and their designated representatives, as well as other representatives from organizations that focus on identified Healthy Montgomery priority areas and emerging issues.

3. Scope of Authority, Structure, and Member Responsibilities Measurement and Evaluation Subcommittee Scope of Authority. The Subcommittee will work with Healthy Montgomery staff to advise Healthy Montgomery priority groups (e.g., obesity partnership, behavioral health task force, and others to be formed in the future) on approaches to: (1) monitor implementation of strategies and measure progress; and (2) develop recommendations for quantifiable, measurable goals and corresponding metrics for their strategies. It is also anticipated that Healthy Montgomery health priority groups may request advice from the Measurement and Evaluation Subcommittee on issues related to data collection, management, analysis, and reporting. The Subcommittee may also advise the HMSC on evaluation of Healthy Montgomery as a coalition. Measurement and Evaluation Subcommittee Co-chairs. Two co-chairs will be chosen from the committee membership to guide the work of the Measurement and Evaluation Subcommittee, including calling and facilitating meetings and setting the meeting agenda. Subcommittee co-chairs will also submit and present a quarterly report to the HMSC. The co-chairs will also monitor progress and finalize deliverables for submission and presentation to the HMSC. Chairs will serve a one-year term with the ability to serve additional terms.

4. Staffing and Resources Healthy Montgomery staff will work with the Measurement and Evaluation Subcommittee co-chairs to provide project management and administrative support, including planning for meetings, facilitating work between meetings and preparing reports and deliverables. Needed project management and administrative support functions may also be fulfilled by HMSC member organizations. Requests for additional support shall be brought to the HMSC’s attention for consideration.

5. Meetings The Measurement and Evaluation Subcommittee will initially meet monthly or at the call of the Co-Chairs in person or by conference call or other electronic means. The schedule may be adjusted as needed. Web conferencing capabilities will be available when needed to facilitate member attendance.

6. Amendments to the Charter Any proposals for revision to this charter shall be presented to the Measurement and Evaluation Subcommittee co-chairs and members for discussion and approval.


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Health Montgomery Measurement & Evaluation Subcommittee Membership Co-Chairs Dr. Michael Stoto Professor of Health Systems Administration and Population Health Georgetown University School of Nursing and Health Studies Dawn Valentine Principal, Valentine Consulting, African American Health Program representative Members Eleni Antzoulatos Community Health and Wellness Program Coordinator, Suburban Hospital Wendy Friar Vice President of Community Health, Holy Cross Hospital Mark Hodge Senior Administrator for Public Health, Montgomery County Department of Health and Human Services Dr. Samuel P. Korper Commission on Aging Kimberly McBride Community Benefit Officer, Holy Cross Hospital Beatrice Miller Sr. Regional Care Coordinator, Carefirst Blue Cross Blue Shield, African American Health Program representative Sulema Middleton-Stewart Montgomery Housing Partnership (liaison for Eat Well, Be Active Partnership) Patricia Rios Supervisor, Community Health Improvement, Community Health and Wellness, Suburban Hospital Dr. Ulder Tillman, Montgomery County Health Officer and Chief, Public Health Services, Montgomery County Department of Health and Human Services Sharon Zalewski Vice President, Primary Care Coalition of Montgomery County


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HEALTHY MONTGOMERYMeasurement & Evaluation Subcommittee Report

Mike Stoto, PhDProfessor of Health Systems Administration and Population Health Georgetown University School of Nursing & Health Studies


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“UNIVERSITY OF KENTUCKY” REPORT DECEMBER 5, 2014Report highlights related to work of HM Measurement & Evaluation Subcommittee


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Measurement Challenges• A third and very fundamental challenge for all of these partnerships is

the intrinsic difficulty of bringing about measurable improvement in the overall health of the community or population group they are serving.

• To make impact on one or more of the overall health measures, a partnership must select a set of factors that science has shown are linked to and drive the overall measure and for which there are evidence-based strategies and sufficient resources for the partnership and their partners to employ in addressing it.

• Selecting the overall health measure(s) a partnership wishes to address and the “intermediate” factors and related metrics on which the partnership will focus resources and efforts is quite challenging; however, making these selections is a financial and moral imperative for partnership leaders.


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Measurement Challenges• Resources for improving community health are scarce.

They must be allocated to targets and strategies that are most likely to have a positive impact on high-priority health needs in the community by: 1. Placing a highly-disciplined focus on a high priority health

measure(s) and a carefully selected set of intermediate factors; and

2. Demonstrating progress on a set of key metrics• The partnerships are more likely to build and maintain the

interest and engagement of their partners, volunteers, and the community at-large and, in doing so, generate support for continued efforts.


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Measurement Challenges• Emerging patterns (#5): Many partnerships continue to be challenged in

developing objectives and metrics and demonstrating their linkages with the overall measure(s) of population health on which they have chosen to focus. • To assess a partnership’s progress toward its goals and fulfill its

accountability to stakeholders, the partnership leaders must adopt measures (intermediate and long-term), implement evidence-based strategies, compile pertinent data, and conduct sound, objective evaluation.

• All partnerships need to evolve beyond tracking “participation” and “processes” to measuring and reporting outcomes and impact.

• Recommendation #7: To enable objective, evidence-based evaluation of a partnership’s progress in achieving its mission and goals and fulfill its accountability to key stakeholders, the partnership’s leadership must specify the community health measures they want to address, the particular objectives and targets they intend to achieve, and the metrics and tools they will use to track and monitor progress.


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PROPOSED CHARTERHM Measurement & Evaluation Subcommittee


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Proposed Charter: Purpose

• To support the HMSC related to Healthy Montgomery measurement and evaluation activities

• To work with HM staff to identify measurement and evaluation approaches for Healthy Montgomery action planning, implementation, and related Triple AIM activities.


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Proposed Charter: Composition• Members of the HMSC and their designated

representatives• Other representatives from organizations that focus on

identified Healthy Montgomery priority areas and emerging issues

• Co-chairs are:• Dr. Mike Stoto (affiliation: academic)• Dawn Valentine (affiliation: African American Health Program)


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Proposed Charter: Scope of Authority, Structure, and Member Responsibilities

• The Subcommittee will work with HM staff to advise HM priority groups on approaches to:

• Monitor implementation of strategies and measure progress; and

• Develop recommendations for quantifiable, measurable goals and corresponding metrics for their strategies.

• It is also anticipated that Healthy Montgomery health priority groups may request advice from the Measurement and Evaluation Subcommittee on issues related to data collection, management, analysis, and reporting.

• The Subcommittee may also advise the HMSC on evaluation of Healthy Montgomery as a coalition.


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Proposed Charter: Staffing & Resources• HM staff • Co-Chairs• HMSC member organizations• Requests for additional support shall be brought to the

HMSC’s attention for consideration


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Questions for HMSC

•Does the proposed charter language capture the intended purpose, role, and scope of the Subcommittee?•Does the Subcommittee have the resources needed to provide the advisory support described in the charter, particularly as the number of Healthy Montgomery priority areas expand?


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healthy montgomery steering committee meeting...

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