SOCIAL DETERMINANTS OF HEALTH: FROM AWARENESS TO ACTION

Julie A. Willems Van Dijk RN, PhD Co-Director County Health Rankings & Roadmaps March 11, 2016

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THIS IS A FOOTBALL … “Gentlemen, this is a football.”

-- Coach Vince Lombardi

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TODAY’S THREE KEY MESSAGES

‣ There are many factors that drive how long and how well we live.

‣ Therefore, we need people from multiple sectors working together to make changes that will improve health.

‣ Kansas City is well poised to harness its collective energy to move health forward.

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6 www.countyhealthrankings.org

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SUCCESSFUL PARTNERSHIPS

Buy-in but uncoordinated:

‣ Competing for Resources

‣ Failure to agree on deadlines and ways of working

Coordinated and facing same way; lack momentum

‣ Promises without delivery ‣ Nobody “walks the talk” ‣ Only easy things get done ‣ Failure to Progress

Willing cooperation but lacks purpose ‣Inertia

‣Running in Circles ‣Teams going nowhere fast

‣Everyone headed in different directions

Center for Creative Leadership

ccl.org

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COLLECTIVE IMPACT: FIVE NECESSARY CONDITIONS

1. Common Agenda: Shared vision for change

2. Shared Measurement: Collecting data and measuring results

3. Mutually Reinforcing Activities: Differentiated while still being coordinated

4. Continuous Communication: Consistent and open communication

5. Backbone Organization: Coordination for the entire initiative and of participating organizations

8 Kania, J. and Kramer, M (Winter, 2011). Collective Impact. Stanford Social Innovation Review. Palo Alto,

CA: Stanford University.

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10 http://www.rwjf.org/en/library/articles-and-news/2015/10/coh-prize-kansas-city-mo.html

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ACKNOWLEDGEMENTS

‣ Robert Wood Johnson Foundation

– Including Abbey Cofsky, Andrea Ducas, Michelle Larkin, Jim Marks, Joe Marx, Don Schwarz, Amy Slonim, Katie Wehr

‣ Wisconsin County Health Rankings & Roadmaps Team

– Including Bridget Catlin, Marjory Givens, Kitty Jerome, Carrie Carroll, Amanda Jovaag, Alison Bergum, Astra Iheukumere

‣ Our Partners

– Including Active Living by Design, Burness, CDC, Dartmouth Institute, Local Initiatives Support Corporation, National Association of Counties, NeighborWorks, United Way Worldwide

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THANK YOU

Julie Willems Van Dijk RN PhD

Associate Scientist & Co-Director

County Health Rankings & Roadmaps

University of Wisconsin Population Health Institute

608-263-6731

willemsvandi@wisc.edu

The IPC pipeline is constructed through programs and services complementing and building on each other.

Results Based Accountability

POPULATION-LEVEL Population-Level Results

•What do we want for our community? (i.e. All children enter Kindergarten ready.) •Conditions of well-being for all (inspirational)

Population-Level Indicators •How are we doing to achieve our results? (i.e. number and percent of children ready for Kindergarten)

PROGRAM-LEVEL Strategies/Programs

•Theory of Change •What will we do to achieve results? (i.e. reading program, summer camps, etc)

Program Goals Performance Measures

•How are we doing to achieve program-level goals?

Source: Trying Hard is Not Good Enough (Mark Friedman, 2009)

2013* 2014 2015

Percent Ready

25% 44% 52%

Families

Through the Imagination Library program, parents of young children receive monthly age-appropriate books. The program has shown to improve family reading habits and a parent's comfort level when reading with their child.

Parent educators are community workers trained in early childhood development who serve as key liaisons with mothers in the community, delivering resources and training in positive parenting practices.

A new program in 2015, the LINKS targeted families with children 0 to 5 years old with no access to formal early childhood setting. The program works to connect parents to resources and re-inforce positive parenting practices.

Policy Pre-K collaborative

Mississippi Department of Education implemented the MKAS monitoring system at the beginning of the 2014-2015 school year. All school districts in the state report k-readiness data using an aligned assessment--STAR Early Literacy.

The creation of the IPC literacy coalition brought together early childhood partners and stakeholders to raise awareness of the importance of reading and improve access to books and other resources in the community.

Programs

Parents as Teachers is an evidence-based maternal home-visitation program. The program provides information, support, and encouragement to parents during their child's crucial early years of life.

In 2014, Promise School participants were more likely to meet or exceed K-readiness benchmarks than non-participants. The summer K-readiness boot camp was expanded from 4 to 6 weeks in 2015.

As data became available to demonstrate the positive impact of multiple "doses" of IPC on K-readiness scores, IPC made an intentional effort to dually enroll participants in Imagination Library and other home visitation programs. Currently over 90% of SPARK and PAT participants are dually enrolled in Imagination Library.

Systems

Promise School was implemented by the school district in 2013. This created a smoother transition to Kindergarten, by allowing incoming students to adjust to the school environment and learn from their future Kindergarten teachers.

Save the Children became the Early Head Start and Head Start provider for Sunflower County. Delta Health Alliance and Save the Children partnered to expand home-based intervention to an additional 50 families in Sunflower County.

During this year, IPC facilitated the alignment of 7 of the 9 formal early childcare providers in Indianola, including private childcare providers, Head Start and the State's Pre-K collaborative. Almost all 4 year olds in formal care receive the same evidence-based curriculum and assessment.

THE EVOLUTION OF KINDERGARTEN READINESS IN INDIANOLA

Delta Health Alliance contact: Josh Davis 662-380-1344 j d a v i s @ d e l t a h e a l t h a l l i a n c e . o r g

Health Starts at Home Partnership Chelsea, MA

Danelle Marable, MA Director, Evaluation and

Strategic Support MGH Center for Community

Health Improvement

Stefanie Shull, MPA-URP Director, CONNECT Program

The Neighborhood Developers

CONNECT Families Face Complex Challenges

• Poverty: 32% of households earn less than $10,000/ year

• Unbanked: 21% do not use banks to pay bills or save

• Limited Education: 30% of adults lack H.S. equivalency

• Language Barrier: 31% speak little or no English

• Isolated: Lack of personal support and professional

networks

These key issues are addressed at CONNECT

by our multiple service partners

Five Partners • Shared Clients • One Location

CORE SERVICES

Centralized Intake Co-location

Data Management Governance Marketing

Fundraising Evaluation

Jobs & Training

Housing

Higher

Educ.

ESL & GED

Banking & Financial

Educ.

Coaching & Peer

Support

Income Supports

Integration of Services

12%

19%

24%

30%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2013 2014 2015 2016 (goal)

CONNECT Bundling Rate

Median gains:

• Net income: $860/month

• Net worth: $2,881

• Credit score: 51 Points

Overall, 47% have seen

gains so far.

24%

46%

58%

75%

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More Services, Stronger Outcomes

Outcomes for Coached Clients

Community Health @

Massachusetts General Hospital

Massachusetts General Hospital

• Founded in 1811

• Harvard teaching hospital

• 950 inpatient beds

• 1.5 million outpatient visits

• 25,000 employees

• Largest NIH research center

Community Health @ MGH

It’s not just about the goldfish. It’s also about the water.

Where we work

How do we address factors that affect health?

CCHI’s Strategies: Working Across the Health Impact Pyramid

Community Health Workers

Youth Development & STEM Education

Multi-Sector Community Coalitions

• 2012 Community Health Needs Assessment: Committee and Focus Groups

• Members of Healthy Chelsea and the newly formed SUDs Leadership Team that came out of the 2012 CHNA

• Partnering on vibrant spaces and asthma grant

• TND Executive Director a member of the MGH Executive Committee on Community Health

• 2016 Adolescent Substance Use and Well-being Assessment

Partnering with The Neighborhood Developers

Setting the Stage for Health Starts at Home @ MGH

Health Starts at Home

END GOAL Stable affordable housing is maintained and results in stronger health outcomes for children.

Theory of Change Model

Housing & Income

Stabilization Services

Housing Maintenance

Services

Improved Children’s

Health Outcomes

Organizational Chart

Participant Flow MGH Chelsea Pediatric & Community Health

Worker Departments Medically complex patients & patients with

housing concerns referred to MGH HSAH Community Health Worker

Roca Roca Families who have child(ren) that are MGH Chelsea Pediatric patients and have

housing concerns are identified

MGH Chelsea Community Health Worker Screening, Consent, Intake

Family Supported to Identify Housing

Housing Stabilization at Connect •Welcome & what to expect, quick screening for housing challenges •Next step in benefit screening, appointment for benefit enrollment made as needed

CONNECT Services for RAFT-Ready Families

(rental assistance ready)

Housing Maintenance at CONNECT

Lessons Learned