Goals and Objectives
The overall goal of this practice was to adopt a place-based approach to implementation of Duval County's CHIP. After the release of Duval County's CHIP, a number of challenges were encountered. Because health improvement efforts are slow-moving and results are not always immediately evident, maintaining active engagement from community partners and local leaders was challenging. Other challenges included helping partners understand their role and ways they can contribute to health improvement efforts. To address these challenges, a place-based approach was adopted that used census-tract level data to identify priority neighborhoods for implementation of Duval County's CHIP. The specific goals of the place-based approach for Duval County's CHIP included:
1) Using a data driven approach to identify priority neighborhoods.
2) Developing inventories of the resources and assets in the priority neighborhoods.
3) Developing an understanding of needs and challenges residents face in the priority neighborhoods.
4) Tailoring action plans to the unique needs and strengths of the priority neighborhoods.
5) Focusing CHIP implementation in the priority neighborhoods.
6) Increasing community partner engagement and building community capacity by fostering strategic partnerships to fill service gaps in the priority neighborhoods.
DOH-Duval initiated a new community health improvement process in 2016 and Duval County's CHIP was released in 2017. Using data to inform health improvement efforts did not stop after the completion of Duval County's Community Health Assessment (CHA) and the identification of priority areas in Duval County's CHIP. Data continued to play an invaluable role throughout the MAPP process and was used to guide implementation of the CHIP. As community partners moved from the planning to implementation phases, sub-county level data was analyzed to aid in the selection of two priority neighborhoods on the Westside of Jacksonville (Hillcrest and Hyde Park). The neighborhoods consistently have the highest number of infant deaths in Duval County, and are also disproportionality impacted by other priority health issues identified in Duval County's CHIP. When compared to Duval County, these two neighborhoods also experience more poverty and unemployment, and have lower levels of educational attainment, insurance coverage, and household income. After the selection of the priority neighborhoods, the following activities were implemented from 2018-2020:
1) Additional demographic, socioeconomic, and health data was analyzed to develop health profiles for the priority neighborhood.
2) Resource inventories were developed for the priority neighborhoods and were used to build strategic partnerships and identify gaps in services.
3) Tailored action plans were developed and implemented based on the unique needs and strengths of the priority neighborhoods.
4) Activities to increase community partner engagement were used to facilitate communication between CHIP partners and provide opportunities to learn about the services each partner provides, the challenges they experience, and opportunities for collaboration.
Health improvement does not occur solely at the government or agency level, but must be expanded and practiced in our homes, workplaces, schools, and faith-based organizations. Expanding partnerships in the community and increasing overall engagement is critical throughout the MAPP process. To this end, DOH-Duval made engaging diverse community partners in the development and implementation of Duval County's CHIP a priority. Critical sectors invited to participate in the development and implementation of Duval County's CHIP included local hospitals and health care organizations, local government, community-based organizations, faith-based organizations, community-based organizations, and educational institutions. Key community partners included:
1) Ability Housing
2) City of Jacksonville
3) Duval County Public Schools
4) Drug Free Duval
5) Feeding Northeast Florida
6) Gateway Community Outreach
7) Inspire to Rise, Inc.
8) Jacksonville Fire and Rescue Department
9) Northeast Florida Healthy Start Coalition
10) The Potter's House International Ministries
11) University of Florida
12) University of North Florida
Meetings were held with community partners to review, analyze, and synthesize key findings from the CHA to inform the development of Duval County's CHIP. During these meetings, community partners had the opportunity to review the assessment findings and make recommendations for additional indicators to include in Duval County's CHA. Strategic health priorities were identified through a facilitated process that examined cross-cutting strategic issues that emerged in the CHA. When establishing health priorities for Duval County's CHIP, feasibility, impact on health outcomes, and the promotion of health equity were considered. Through this process, the following strategic health priority areas were identified for Duval County's CHIP: Healthy Families and Healthy Babies, Healthiest Weight, Behavioral Health, and Infectious Diseases. Access to care and healthy equity were identified as cross-cutting strategies to be addressed throughout the CHIP.
After the release of Duval County's CHIP, Hillcrest and Hyde Park were identified as priority neighborhoods for implementation and comprehensive inventories were created of the resources and assets in these neighborhoods. These inventories included assets such as a list of faith-based organizations, social service organizations, schools and day care centers, health care clinics, apartments, bus routes, and barber shops and beauty salons. These inventories were used to build strategic partnerships and tailored action plans, with the ultimate goal of increasing community capacity to improve health outcomes. As new partnerships developed in the priority neighborhoods, representatives from organizations were invited to join the CHIP partnership and helped further inform the development of action plans. Tailored action plans were developed by identifying and building relationships with trusted organizations in the priority neighborhoods, identifying their challenges or needs, and connecting CHIP partners to the trusted organizations to expand the services offered to residents. Action plans were regularly updated as new partners and opportunities for collaboration were identified. Inspire to Rise, Inc. is a community resource center located in the priority neighborhoods, with a mission to provide residents of Jacksonville's Westside with access to services necessary to lead healthy lives. As a trusted organization, Inspire to Rise, Inc. was able to quickly establish several collaborations with CHIP partners that increased their capacity to bring new programs and services to residents in 2019:
1) Volunteers in Medicine received funding from City of Jacksonville to establish and operate a free health clinic two days a week at Inspire to Rise, Inc.
2) Northeast Florida's Healthy Start Coalition partnered with Inspire to Rise, Inc. to offer Fatherhood PRIDE, a program providing free parenting classes to male caregivers. Inspire to Rise, Inc. also became a location for the Azalea Project, a program providing outreach, education, and services to substance-using pregnant women.
3) Drug Free Duval, City of Jacksonville, Jacksonville Fire and Rescue Department, and DOH-Duval partnered with Inspire to Rise, Inc. to offer free overdose prevention training and NARCAN kits.
4) Jacksonville Fire and Rescue Department, Jewish Family Community Services, and the Max Block Food Pantry partnered with Inspire to Rise, Inc. on an initiative that includes a free NARCAN kit in each food bag that is distributed.
5) UF/IFAS Extension established free nutrition education and cooking classes at Inspire to Rise, Inc.
6) Planned Parenthood partnered with Inspire to Rise, Inc. to provide education to youth and parents on HIV, other STDs, and pregnancy prevention.
7) Tobacco Free Duval and Northeast Florida AHEC partnered with Inspire to Rise, Inc. to provide tobacco cessation classes.
8) DOH-Duval partnered with Inspire to Rise, Inc. to offer free walk-up COVID-19 testing to residents.
Local Health Department's Role
DOH-Duval served as conveners of the MAPP process and conducted data analysis that assisted community partners in identifying priority neighborhoods for implementation of Duval County's CHIP. DOH-Duval's role was also to connect community partners, provide opportunities where stakeholders could convene to identify opportunities for collaboration, and monitor evaluation of Duval County's CHIP. In order to develop actionable and measurable action plans, DOH-Duval employed the Results-Based Accountability (RBA) Model, which focused on population health improvement as the end goal, with program performance as a means to that end. The usefulness of the RBA approach is that it starts with the desired end in mind (outcome) and develops a set of evidence-based, targeted strategies to attain the outcome. RBA is the framework used for Turning the Curve, a process of positively changing the course of unwanted health trends through the development of performance standards and measures, progress reports, and ongoing performance and quality improvement. In combination with MAPP as a guiding framework, this approach helped define how CHIP partners would work in collaboration to improve health outcomes in the neighborhoods of Hillcrest and Hyde Park.
Throughout this process, increasing stakeholder engagement was critical. DOH-Duval coordinated several community partner engagement activities to identify opportunities for collaboration that built upon the existing strengths in Hillcrest and Hyde Park. Activities used to foster collaboration among community partners included:
1) At each CHIP meeting, a portion of the agenda was dedicated for a Community Partner Spotlight” presentation. These presentations provided the opportunity for CHIP partners to learn more about other agencies in the community, the challenges they face, and ways they believe they can collaborate with other community partners to improve health outcomes.
2) A community partner networking event was hosted to allow CHIP partners the opportunity to learn about the services each organization provides to the community, the challenges or barriers they experience, and identify opportunities for collaboration.
3) Each CHIP partner also created a story image poster that consisted of their organization's name, mission and vision, populations served, services, challenges, and a powerful image unique to their organization that conveyed a message related to their work in the community. These posters were used to identify opportunities for collaboration, as well as to onboard new CHIP partners.
It was also important to take steps to ensure equitable, meaningful, and representative collaboration with the target population of Hillcrest and Hyde Park. These steps included:
1) Holding meetings in the priority neighborhoods. Several meetings were held at HUD apartment complexes in the priority neighborhoods. Residents were encouraged to attend, share their perspectives on factors that impact health and quality of life, and provide feedback on the action plans. Meetings were also held at faith-based organizations and community-based organizations in the priority neighborhoods.
2) Identifying trusted organizations in the priority neighborhoods, identifying their needs or challenges, and building strategic partnerships to increase the capacity of trusted organizations.
3) Collecting primary data on the needs and issues faced in Hillcrest and Hyde Park through community engagement surveys, community meetings, key informant interviews, and surveys with residents. Primary data assisted with gaining a more in-depth understanding of factors impacting health and quality of life from the perspective of residents living in Hillcrest and Hyde Park, and from the perspective of community partners serving these neighborhoods.