Community Collaboration with the Aging Sector

In January 2019, WCHIP decided to incorporate a focus on older adults' health by strengthening partnerships with the aging sector into the revision of the 2017-2019 Community Health Improvement Plan (CHIP) as a part of the Health Equity Strategic Priority Area. To align with the community's focus, this was also included in the 2019-2021 DOH-Walton Strategic Plan. The goal of this model practice is to increase collaboration with the aging sector by aligning the MAPP framework and the AARP Network of Age-Friendly States and Communities guidance. The objectives were (1) By December 31, 2019, collaborate with four aging sector partners on community events or initiatives; (2) By June 30, 2019, collaborate with one local government or municipality to apply for the AARP Network of Age-Friendly States and Communities; (3) By July 31, 2019, conduct community survey of older adults to determine subjective needs.

For (1) By December 31, 2019, collaborate with four aging sector partners on community events or initiatives, DOH-Walton and WCHIP actively collaborated with five of the aging sector partners on community events or initiatives. DOH-Walton did not come in trying to lead the practice, but to just facilitate and garner strategic collaboration on specific activities. DOH-Walton was able to support initiatives already in place, and this helped receive buy-in” by aging sector partners. This exceeded the goal of four community collaborations. The collaborations were based on the environmental scan completed in January 2019. The collaborations were both with established partners, Northwest Florida Area Agency on Aging and Walton Okaloosa Council on Aging, and new partners, Emerald Coast Hospice, DeFuniak Springs Life Enrichment Center, and AARP Florida. The first collaboration occurred in May 2019 when DOH-Walton and WCHIP sponsored the Northwest Florida Area Agency on Aging's Annual Regional Training Symposium. The symposium was attended by aging sector service providers, including both social and healthcare services, in Northwest Florida. At the event, DOH-Walton and WCHIP provided attendees with topical information and shared the vision of Age-Friendly Walton. Attendees were invited to the next WCHIP community meeting. In June 2019, Emerald Coast Hospice facilitated the Virtual Dementia Tour for DOH-Employees, including those that are assigned a role at the special needs shelter during emergencies, and the public for Alzheimer's and Brain Awareness Month. The Virtual Dementia Tour is an evidence-based method of building a greater understanding of dementia. During the Virtual Dementia Tour experience, trained facilitators guide participants outfitted with patented devices that alter their senses while they tried to complete common everyday tasks and exercises. The Virtual Dementia Tour enabled participants to experience for themselves the physical and mental challenges those with dementia face and used the experience to provide better person-centered care, especially in a special needs shelter in an emergency. There were over 50 participants for the Virtual Dementia Tour. Emerald Coast Hospice needed a location to host the Virtual Dementia Tour in Walton County, so the collaboration was mutually beneficial. Starting July 2019, DeFuniak Springs Life Enrichment Senior Center hosted the Diabetes Prevention Program (DDP) classes for older adults. DPP is the CDC-recognized lifestyle change program, a research-based program focusing on healthy eating and physical activity which showed that people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old). In November 2019, Walton Okaloosa Council on Aging hosted the Walton County Veterans' Information Fair. Based on the data gathered in the initial assessment, the executive director of Walton Okaloosa Council on Aging believed the number of veterans in Walton County was underestimated. In an attempt to better link those veterans that are not receiving services to available services, the first Veteran's Information Fair was established. In November 2019, AARP Florida sponsored the Healthy Walton Summit and highlighted available programs. AARP Florida's Associate State Director for Advocacy & Outreach participated in the discussion panel to address the needs of older adults and available AARP resources.

For (2) By June 30, 2019, collaborate with one local government or municipality to apply for the AARP Network of Age-Friendly States and Communities. In Fall of 2018, DOH-Walton entered the Age-Friendly Public Health Learning Collaborative, facilitated by the Florida Department of Health and Trust for America's Health, and sponsored by the John A. Hartford Foundation. The participants in the network were given $5,000 to support any activities targeted to older adults. The overall goal for the initiative is to implement a public health framework to improve the health and well-being of older adults, focusing on areas where public health can support, complement, or enhance aging services. The initiative promotes the innovative aging work in Florida already under way, including the implementation of Age-Friendly Communities, which help to build rapport between the public health and aging sectors and contribute to a national movement to advance an age-friendly public health system. Most of this practice was initiated from the inclusion of this collaborative. Starting in January 2019, WCHIP held monthly meetings with the aging sector specifically to launch the Age-Friendly Walton initiative. The attendees of the meetings completed an environmental scan, identified areas of improvement, and decided to work toward applying for inclusion in the AARP Network of Age-Friendly States and Communities. In April 2019, DOH-Walton and the Walton Okaloosa Council on Aging, with the support of the Walton County Board of County Commissioners via official resolution, drafted and submitted the application to the AARP Network of Age-Friendly States and Communities. In May 2019, Walton County, Florida become the first community in the Florida Panhandle to be included in the network. Membership into this network means that the community's elected leadership has made the commitment to actively work toward making their county a great place to live for people of all ages. Participation in the network involved following a multi-step process of improvement, similar to the MAPP framework. Inclusion in the AARP network also comes with inclusion in the World Health Organization's (WHO) Global Network for Age-friendly Cities and Communities. Aging sector participants in 2019 included: DOH-Walton, Coastal Seniors of South Walton, Tri-County Community Council – Transportation, Walton Okaloosa Council on Aging, Humana Medicaid, Walton County Prevention Coalition, Walton County Planning Department, Emerald Coast Hospice, Northwest Florida Area Agency on Aging, Okaloosa-Walton Medical Reserve Corps, Caring and Sharing of South Walton, SoWal Community Chaplain, Kindred at Home, Walton County Housing Authority, WZEP 1460 AM, Sacred Heart Hospital on the Emerald Coast, Walton Community Health Center, Pancare of Florida, Homeless and Housing Alliance, Habitat for Humanity – Walton County, Chautauqua Healthcare Services of Lakeview Center, University of Florida IFAS Extension Office, Walton County Government, AARP Florida, Catholic Charities of Northwest Florida, DeFuniak Springs Life Enrichment Center, and Florida Department of Elder Affairs.

For (3) By July 31, 2019, conduct community survey of older adults to support the Community Themes and Strengths Assessment of the MAPP framework, DOH-Walton utilized the new community aging-sector partners to administer a survey to determine the community's needs for the 2020-2022 CHIP. Hospice agencies took surveys into the homes of clients, and local senior centers promoted the survey to their patrons. The results of the survey were delineated to determine what older adults believe the top community health issues were locally. With 112 responses, the top issues for those over the age of 60 were unaffordable and inaccessible housing, limited community resources for vulnerable populations (older adults, individuals with disabilities, homeless, etc.), and crime. The top indicated unhealthy behavior” in their community was drug use.

Though there was a mini-grant that initiated this practice, most of the expenses from the $5,000 were travel-related costs to statewide age-friendly meetings, promotional items, and the sponsorship for the Northwest Florida Area Agency on Aging's Annual Regional Training Symposium. These costs are not required to implement this practice. This practice was successful due to the ability to coordinate existing resources through new community partnerships. DOH-Walton facilitated the meetings and planning process for community partners, and the implementation was a collaborative effort with different aging sector taking lead for certain activities. This practice was led by the part-time CHIP Facilitator and the part-time CHIP Co-Facilitator, already established positions budgeted through general revenue.

Objectives: (1) By December 31, 2019, collaborate with four aging sector partners on community events or initiatives; (2) By June 30, 2019, collaborate with one local government or municipality to apply for the AARP Network of Age-Friendly States and Communities; (3) By July 31, 2019, conduct community survey of older adults to determine subjective needs.

Using the program impact theory, the practice met all of the intended immediate outcomes and objectives. A formative process evaluation was completed by aging sector partners that attend meetings to determine if the practice was successfully engaging new partners by probing questions. Both quantitative and qualitative data was collected to determine if the practice was successful. DOH-Walton and WCHIP looks at performance measures quarterly.

The on-going quantitative performance indicators related to this practice are: (1) Number of community events or initiative collaborations with age sector partners; (2) Number of local government or municipalities in the AARP Network of Age-Friendly States and Communities, and (3) Number of aging sector partners that attend meetings regularly. This data collected helped DOH-Walton and WCHIP gage the success of the meetings and the productivity of short-term outcomes of increasing partners and collaboration. There was a total of five collaborations with aging sector partners. Walton County completed all of the requirements of the AARP Age-Friendly States and Communities and submitted the application in April 2019. Walton County became the first community in the Florida Panhandle to be included in the network in May 2019. The number of aging sector partners attended meetings increased from 21 in the first quarter of 2019 to 28 in fourth quarter of 2019.

A qualitative four-point Likert scale community engagement survey was conducted at the end of all meetings to collect primary data on if the meetings meet the expectation and meeting's objectives. The survey questions included: (1) My opinions were valued during this meeting; (2) There was enough time for me to provide input during the meeting; (3) The topics discussed during the meeting met the needs of my community; (4) The meeting time and location met my needs; (5) Based on your experience, how likely are you to return to another meeting?; (6) Please list additional needs for your community that were not discussed today. The process was continuously evaluated to see if improvements can be made based on the feedback given. The WCHIP Steering Committee reviewed meeting and partnership evaluations to determine if modifications are necessary. The objectives set by DOH-Walton and WCHIP were all met or exceeded. In the fourth quarter of 2019, over 92 percent of respondents stated they either agreed or strongly agreed with the first five answers. 96 percent of respondents stated they are likely or very likely to return to another meeting. When evaluating the negative responses, there were respondents that felt that specific community needs were not being addressed, specifically access to dental care and primary care.

Two administrative modification were made to the practice. Initially, the aging sector was meeting separate from the larger WCHIP community meeting. After the planning stage was completed, WCHIP Steering Committee found little need to have a separate community meeting. After evaluating the aging sector, they did not have time to attend both meetings, so the aging sector meeting was incorporated into the larger WCHIP community meeting as a workgroup agenda item. This was actually better because more of our community partners became aware of the resources available for older adults. Secondly, the incorporation of the aging sector activities in the CHIP were changed due to partner feedback. Since these activities started at the end of the 2017-2019 CHIP, the easiest way to quickly add the goals and objectives were to add it to one specific strategic priority area, the Health Equity Workgroup. When evaluating this strategy for the new 2020-2022 CHIP, WCHIP Steering Committee presented the idea of incorporating an objective specific to the aging sector to each of the new strategic priority areas: Healthy Homes, Healthy Places, Healthy People, and Healthy Behaviors. This is due to the community survey that was conducted in the Summer 2019. Two out of the three identified community health issues and two out of three identified community unhealthy behaviors were the same, so the WCHIP Steering Committee believed that it was the best use of resources to include aging-specific activities into the priority area workgroups. An example of this is for Strategic Priority 2: Healthy Places. The goal is improve the built environment to support healthy lifestyles of individuals across the lifespan.” The aging-specific activity will be focused on the planning and development of multigenerational parks.

This practice is the first step of a continuous evaluation of if we are meeting the needs of older adults in Walton County. With the primary data collected from the community survey in Summer 2019, older adults indicated that top issues for those over the age of 60 were unaffordable and inaccessible housing, limited community resources for vulnerable populations (older adults, individuals with disabilities, homeless, etc.), and crime. These survey results will lead into more programmatic and prevention-orientated priorities addressed and in the 2020-2022 CHIP: fall prevention, medication security, older driver safety, food access, affordable housing, and multigenerational parks. The long-term effects of this practice will be evaluated in-depth based on quantitative data of the health outcomes addressed.

DOH-Walton learned that targeting efforts to grow one sector of partners is sometimes the best approach, especially for smaller local health departments with limited resources. The ability to focus on the aging sector allowed for a comprehensive planned approach. DOH-Walton and WCHIP discovered several lessons learned based on this practice relating to partner collaboration. The aging sector is an important partner to have at the table when planning health initiatives. Though typically associated with words like vulnerable” or at-risk,” the majority of older adults are part of a thriving and active community. The way public health communicates messages to older adults is imperative. Simply including stock images of active older adults in the graphics and marketing materials made a big difference to the aging sector. Second, it is vital to find where the synergy is in the community around specific health concerns or target populations. Though this practice worked in Walton County, it might be harder to implement in other communities were aging issues are not as prominent. This process could be adapted to other target populations. Third, sometimes public health's role is to facilitate, not to dictate. DOH-Walton was able to sit back and let the aging sector lead much of this practice. With WCHIP being a robust partnership, DOH-Walton was able to facilitate the MAPP framework with the AARP Network of Age-Friendly States and Communities guidance, and the community partners drove it to where they strategically thought it needed to go.

At the conclusion of the 2017-2109 CHIP, DOH-Walton and WCHIP Steering Committee completed an analysis to determine if aging-specific focuses should be included in the new 2020-2022 CHIP. A decision that the growth of partners in the aging sector helps support these activities was concluded. With continuity in mind, DOH-Walton and WCHIP hosted the 2019 Healthy Walton Summit in November 2019. At the summit, 75 community partners discussed health issues and the four priorities for the 2020-2022 CHIP: Healthy Homes, Healthy Places, Healthy People, and Healthy Behaviors. AARP Florida sponsored the event and provided attendees with information regarding their programs. Each priority workgroup is required to have at least one objective addressing older adults. Each of these priorities have a community-led workgroup that make sure that this practice is sustainable. By ensuring each workgroup has at least one objective focused on the aging sector, this will allow this practice to remain so that the newly engaged stay at the table and that new partners are acquired going forward. An example of this is related to the Healthy Behaviors Workgroup, which focuses on substance use and mental health. A part of their workplan is to engage pharmacies to better equip them with tools to promote medication safety. This will get local pharmacies as partners in the aging sector. For the Healthy People Workgroup, local hospice and home health agencies are coordinating fall prevention messaging. Providing specific aging sector partners tasks with deadlines also helps ensure that there is continuity and continuation of this practice. In addition, the attendees identified some additional community partners needed to address older adult issues. One major group of partners that were identified were faith-based institutions. The idea of starting a Healthy Walton Faith initiative was discussed, similar to the already implemented Healthy Walton Worksites initiative.

DOH-Walton and WCHIP Steering Committee do not expect any confounding happenstance where this practice cannot be continued. Also, the ability to use the framework and approach of this practice as a model for other community sectors is foreseen.