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A Place-based Approach to Implementation of Duval County’s CHIP.

State: FL Type: Promising Practice Year: 2021

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Florida Department of Health in Duval County
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A Place-based Approach to Implementation of Duval County’s CHIP.

The Florida Department of Health in Duval County (DOH-Duval) is the local county health department in Jacksonville, FL. Duval County comprises close to 928 square miles located on the northeastern coast of Florida. It has a population of 924,229 residents (49% male and 51% female). The median household income is $53,473. In addition, Duval County's population is 61% White, 30% Black, and 9% other races, with approximately 9% having Hispanic ethnicity. An estimated 16% of residents received federal food assistance benefits in the last 12 months.

 

The implementation of a Community Health Improvement Plan (CHIP) is a critical component of the Public Health Accreditation Board (PHAB) process. Utilizing the National Association of City and County Health Official's (NACCHO) Mobilizing for Action through Planning and Partnerships (MAPP) framework, the following strategic priorities were identified in Duval County's 2017-2022 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.

 

Public Health Issue and Model Practice

After the release of Duval County's CHIP, a number of challenges were encountered. Because health improvement efforts are slow-moving, maintaining engagement from community partners and local leaders proved 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. This approach may serve as a model practice for other communities, particularly when partner engagement is low or when addressing health disparities based on geographic location is a priority. The goals of the place-based approach for Duval County's CHIP included:

1) Using a data driven approach to identify priority neighborhoods.

2) Tailoring action plans to the unique needs and strengths of priority neighborhoods.

3) Focusing CHIP implementation in priority neighborhoods.

4) Increasing engagement by fostering strategic partnerships to fill gaps and build capacity in priority neighborhoods.

Key Activities Implemented

Sub-county level (i.e., census tract) data was used to select two priority neighborhoods on the Westside of Jacksonville (Hillcrest and Hyde Park) for implementation of Duval County's CHIP. These neighborhoods have the highest number of infant deaths in Duval County, and are also disproportionality impacted by other priority health issues. 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:

1) Additional demographic, socioeconomic, and health data was analyzed to develop health profiles for the priority neighborhoods.

2) Resource inventories were developed for the priority neighborhoods and were used to build strategic partnerships.

3) Tailored action plans were developed based on the unique needs and strengths of the priority neighborhoods. 

4) Engagement activities were implemented to encourage CHIP partners to identify opportunities for collaboration.

 

Results and Outcomes

A place-based approach to implementation of Duval County's CHIP allowed for focused health improvement efforts, strengthened partnerships, and brought needed services to the priority neighborhoods. The development of resource inventories assisted in identifying service gaps and community assets, such as Inspire to Rise, Inc. Established in 2018, Inspire to Rise, Inc. aims to provide residents of Jacksonville's Westside with access to services necessary to lead healthy lives. Inspire to Rise, Inc. developed several collaborations with CHIP partners that increased their capacity to provide new programs and services to residents, including:

 

1) Volunteers in Medicine established a free health clinic at Inspire to Rise., Inc. that provided services to 51 patients.

 

2) Northeast Florida's Healthy Start Coalition partnered with Inspire to Rise to offer Fatherhood PRIDE, a program providing parenting classes to male caregivers. Inspire to Rise also became a location for the Azalea Project, a program providing education, and services to substance-using pregnant women. 23 participants have accessed Healthy Start services at Inspire to Rise, Inc.

 

3) Drug Free Duval, City of Jacksonville, Jacksonville Fire and Rescue Department, and DOH-Duval partnered with Inspire to Rise, Inc. to offer overdose prevention training and NARCAN kits. 274 residents participated in overdose trainings hosted at Inspire to Rise, Inc.

 

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 food bags that are distributed. 391 food bags and NARCAN kits have been distributed to families in need.   

 

5) UF/IFAS Extension established free nutrition education and cooking classes at Inspire to Rise, Inc. 32 residents participated in the classes.   

 

6) Planned Parenthood partnered with Inspire to Rise, Inc. to provide education on HIV, other STDs, and pregnancy prevention. 8 residents have participated in the program.

 

7) Tobacco Free Duval and Northeast Florida AHEC partnered with Inspire to Rise, Inc. to provide provide tobacco cessation programming. 23 residents have participated in the program.

 

8) DOH-Duval partnered with Inspire to Rise, Inc. to offer free walk-up COVID-19 testing to 970 residents.

 

Public Health Impact and Factors Facilitating Success

A place-based approach allowed the CHIP partnership to build upon existing strengths within the priority neighborhoods to further health improvement efforts. Several factors facilitated success:

 

1) Inspire to Rise, Inc. quickly became a key partner. Inspire to Rise, Inc. is a trusted organization that brings needed services to the priority neighborhoods. By connecting our CHIP partners, new services were offered at Inspire to Rise, Inc. at minimal cost, thereby increasing the sustainability of health improvement efforts.

 

2) Treating the CHIP as a living document allowed action plans to be updated as new opportunities for collaboration emerged.

 

3) The place-based approach changed the dialogue among CHIP partners from How is it possible to improve health in a community the size of Duval County?” to What can we do to support residents of Hillcrest and Hyde Park lead healthier lives?” This shift in dialogue among CHIP partners ultimately increased community partner engagement in health improvement efforts.  

 

The website for the DOH-Duval is www.duval.floridahealth.gov.

Target Population

Duval County has a population of 924,229 residents (49% male and 51% female). The population is approximately 61% White, 30% Black, and 9% other races, with approximately 9% having Hispanic ethnicity. The median household income is $53,473, 7% of residents are unemployed, 16% live in poverty, and 16% received federal food assistance (SNAP) benefits. In the past, Duval County's CHIP planned, implemented, and monitored health improvement efforts for the county overall. However, each neighborhood in Duval County  faces its own health challenges. Moreover, prior evidence has highlighted the important role that one's neighborhood plays as predictor of health status. Adopting a place-based approach for implementation of Duval County's CHIP, allowed for the identification of priority neighborhoods and the tailoring of action plans to address the unique strengths and challenges of the priority neighborhoods.

 

Based on a review of demographic, socioeconomic, and health data at the census-tract level, the neighborhoods of Hillcrest and Hyde Park were selected as priority neighborhoods for implementation of Duval County's CHIP. Combined, these two neighborhoods have a population of approximately 13,585 residents and, therefore, implementation of Duval County's CHIP was focused on approximately 2% of Duval County's overall population. While this may be a small percent of the total population, health improvement efforts are likely to have a greater impact on the overall health of a community when they reach residents with the greatest need. Below are select indicators that informed the decision to select Hillcrest and Hyde Park as priority neighborhoods:

 

1) 17% of residents 25 years or older in Hillcrest do not have a high school diploma, compared to 7% for Duval County.

 

2) 16% of residents in Hyde Park were unemployed, compared to 7% for Duval County. 39% of residents in Hillcrest lived in poverty, compared to 16% for Duval County.

 

3) The median household income in Hillcrest ($28,535) and Hyde Park ($37,538) was significantly lower than in Duval County ($53,267).

 

4) More residents in Hillcrest (36%) and Hyde Park (41%) received federal food assistance (SNAP) benefits in the past 12 months than in Duval County (7%).

 

5) Although Hillcrest and Hyde Park represent only 2% of Duval County's population, these neighborhoods accounted for 4% of infant deaths in Duval County from 2014-2018. During this time period, 18% of live births in Hillcrest and 19% of live births in Hyde Park were preterm, compared to 7% for Duval County.

 

6) From 2014-2018, the rate of homicide deaths in Hillcrest (29.0/100,000) and Hyde Park (36.7/100,000) were significantly higher than in Duval County (12.8/100,000).

 

7) Hillcrest and Hyde Park are located in zip codes 32205 and 32210. These two zip codes had the highest number of deaths in Duval County due to overdose and suicide in 2018.

 

Addressing Health Inequities

The places where people live, learn, work, and play affect a wide range of health risks and outcomes. Environmental and social factors (e.g., access to health care, early intervention services, high quality education, employment opportunities, and healthy food options) influence health status, quality of life, and well-being. By adopting a place-based approach to chronic disease prevention and health promotion efforts, implementation of Duval County's CHIP focused on creating healthy neighborhoods where all residents have the opportunity to reach their full health potential. As our community partners moved from the planning to implementation phases, data was reviewed at the sub-county level (i.e., census tract) to aid in the selection of two neighborhoods on the Westside of Jacksonville, Hillcrest and Hyde Park, as priority neighborhoods for implementation of Duval County's CHIP.

 

Our approach to addressing health inequities, began by first gaining a more in-depth understanding of the unique strengths, needs, and health challenges of the priority neighborhoods. This was accomplished by:

 

1) Additional demographic, socioeconomic, and health data was analyzed at the census-tract level to develop comprehensive health profiles for Hillcrest and Hyde Park. Data sources included the Florida Department of Health Vital Statistics, United States Census Bureau – American Community Survey, Behavior Risk Factor Surveillance System (BRFSS), and United States Department of Agriculture – Food Access Research Atlas. The majority of census-tract level data used to create the health profiles is available on flhealthcharts.com and floridatracking.com. In addition, both websites have a community mapping tool that visualizes health data by census tract, which aided in identification of priority neighborhoods.

 

2) Primary data was also analyzed to inform health improvement efforts through community engagement surveys, community meetings, key informant interviews, and surveys with residents. Primary data assisted with gaining a more in-depth understanding of the 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.

 

3) Comprehensive inventories were developed of the resources and assets in Hillcrest and Hyde Park. These inventories included assets such as a list of faith-based organizations, community-based organizations, schools, day care centers, health care clinics, apartments, bus routes, and barber shops and beauty salons. These inventories were used to build strategic partnerships and identify gaps in services.

 

4) Action plans were tailored to the unique needs and strengths of Hillcrest and Hyde Park. Action plans were developed by identifying trusted organizations in these neighborhoods and connecting CHIP partners to these organizations to expand the services offered to residents. Inspire to Rise, Inc. is an example of a community resource located in the priority neighborhoods that established several collaborations with CHIP partners to increase their capacity to offer new programs and services (e.g., free health care clinic, parenting classes, food pantry). An additional trusted organization that Duval County CHIP partners worked closely with was The Potter's House International Ministries. CHIP partners collaborated with The Potter's House Healthcare Ministry to supplement services already offered to the community by identifying opportunities provide free cooking classes, health care screenings, swimming classes, and overdose prevention training.

 

5) Community partner engagement activities were utilized to identify opportunities for collaboration that built upon the existing strengths in Hillcrest and Hyde Park. At each CHIP meeting, a portion of the agenda was dedicated to a Community Partner Spotlight presentation, and a community partner networking event was also hosted. The goal of both engagement strategies was to provide 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. The partnerships that developed as a result of these engagement strategies, expanded the ability of CHIP partners to use their collective strength to improve health outcomes.

 

6) A healthy equity approach also involves individual organizations reviewing internal policies and programs with a health equity lens. When developing the CHIP, a review of public health policies and programs that support health improvement efforts in each of the priority areas was conducted and opportunities for additional policies and programs were identified. For example, DOH-Duval‘s Maternal and Child Health division established a Neonatal Abstinence Syndrome Workgroup and worked with local community partners to implement a Plan of Safe Care initiative. A Plan of Safe Care ensures the care and treatment needs of infants with prenatal substance exposure are met. In addition, a protocol was developed and implemented requiring mandatory behavioral health screening of all Healthy Start and DOH-Duval maternity clients. Duval County CHIP partners continue to work together to identify additional opportunities for policies and programs that can be implemented to support healthy equity and positive health outcomes for residents.  

               

Innovation

Using a place-based approach for implementation of the CHIP is an innovative way to implement the MAPP process. Because health improvement efforts are slow-moving and results are not always immediately evident, maintaining active engagement from community partners and local leaders can be challenging. Community partners may also have a difficult time understanding their role and ways they can contribute to health improvement efforts. Adopting a place-based approach for implementation of Duval County's CHIP, proved to be a beneficial approach to address common challenges many communities face when implementing the MAPP process. In addition, developing tailored action plans for priority neighborhoods that centered around building the capacity of trusted organizations allowed health improvement initiatives to be implemented in a sustainable manner. The place-based approach shifted the conversation among CHIP partners from one focused on the barriers and challenges of health improvement efforts, to a more focused conversation on how partners can work with existing organizations in the priority neighborhoods to build capacity to improve health outcomes.

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.

 

Program Implementation

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.

 

Stakeholder Involvement

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.

 

 

 

 

Cost for Implementation

The overall cost of the place-based approach to implementation of Duval County's CHIP was minimal. One staff member had a dedicated role of planning and facilitating meetings, fostering collaborative relationships among community partners, conducting data analysis, and writing annual progress reports summarizing progress made and next steps. Their salary was paid in part with a $35,000 Preventive Health and Health Services Block Grant from the Florida Department of Health, Bureau of Chronic Disease Prevention. To partially fulfill internship requirements, an MPH student from the University of North Florida created the community resource inventories for Hillcrest and Hyde Park and assisted with data analysis. In addition, a $10,000 mini grant was received from the Florida Department of Health, Environmental Public Health Tracking Program to fund the creation of health profiles for Hillcrest and Hyde Park, as well as to conduct surveys and key informant interviews in these neighborhoods. Data is updated on a regular basis and used to inform and monitor health improvement efforts. The services provided to residents of Hillcrest and Hyde Park were funded by existing or new grants that CHIP partners received, funding from City of Jacksonville, and through in-kind donations of space by community-based organizations, such as Inspire to Rise, Inc. and The Potter's House International Ministries.  

 

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) Tailoring action plans to the unique needs and strengths of priority neighborhoods.

3) Developing an understanding of needs and challenges residents face in the priority neighborhoods, as well as the resources and assets that exist.

4) Focusing CHIP implementation in priority neighborhoods.

5) Increasing engagement and building community capacity by fostering strategic partnerships to fill service gaps in the priority neighborhoods.

 

Results and Outcomes

Although a cost-effectiveness study has not been conducted, adopting a place-based approach to implementation of Duval County's CHIP allowed for focused health improvement efforts, strengthened community partnerships, and brought needed services to the priority neighborhoods. The development of comprehensive resource inventories assisted in identifying gaps in services and community assets, and were used to engage local community leaders. Inspire to Rise, Inc. was identified as a key community asset in the priority neighborhoods. The mission of Inspire to Rise, Inc. is to provide residents of Jacksonville's Westside with access to support and services necessary to lead healthy lives. Inspire to Rise, Inc. is located in the priority neighborhoods for Duval County's CHIP (in zip code 32210) and established several collaborations with CHIP partners that increased their capacity to bring new programs and services to residents, including:

 

1) Volunteers in Medicine received $97,871 in funding from the City of Jacksonville to establish a free health clinic at Inspire to Rise, Inc. The clinic operates two days a week at Inspire to Rise, Inc. and provides primary health care services to the working uninsured. Prior to receiving this funding, Volunteers in Medicine operated one health clinic located in downtown Jacksonville. However, the majority of patients accessing services at Volunteers in Medicine reside on the Westside of Jacksonville in zip code 32210. In addition, in 2019, residents of zip code 32210 had the highest emergency room utilization rates in Duval County. It is so important, now more than ever, to bring healthcare services to the people who lack access to them,” Jennifer Ryan, CEO of Volunteers in Medicine, said. Meeting Aida Seeraj, the founder of Inspire to Rise, Inc. was destiny. Her community center … is exactly where Volunteers in Medicine needs to be.” During its short time in operation, 51 patients received primary health care services at the Volunteers in Medicine clinic located 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 also became a location for the Azalea Project, a program providing outreach, education, and services to substance-using pregnant women. Previously, the only location where these programs and services were offered was in downtown Jacksonville. Aida Seeraj, Inspire to Rise Founder, said, We are unbelievably grateful for this collaborative partnership! The Northeast Florida Healthy Start Coalition and Inspire to Rise, Inc. share a common vision and mission to strengthen families, break the cycle of substance use, prevent incidents of substance-exposed newborns, and ensure that all babies have healthy birth outcomes and live to see their first birthday! Our common belief is that Stronger Families = a Stronger Community. We are excited and honored to partner with the Northeast Florida Healthy Start Coalition.” To date, 23 participants have accessed Healthy Start programming and services at Inspire to Rise, Inc.

 

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. Drug Free Duval received funding from the City of Jacksonville and through DOH-Duval's CDC Overdose Data to Action grant to provide overdose prevention training to community members. The training focused on educating community members on recognizing the signs and symptoms of overdose and the availability and use of NARCAN. All residents that participated in the training received a free NARCAN kit. Jacksonville Fire and Rescue Department's Safe and Healthy Neighborhoods Project provided funding for the NARCAN kits through a SAMHSA grant. To date, 274 residents participated in overdose prevention trainings hosted at Inspire to Rise, Inc. and received a free NARCAN kit. Evaluation of the trainings demonstrated increases, on a scale from 1-5, from pre-test to post-test in the following areas: knowledge of NARCAN (pre-test = 2.3, post-test = 3.8) knowledge of the Good Samaritan Law (pre-test = 2.0, post-test = 3.8), confidence in the ability to recognize the signs and symptoms of overdose (pre-test = 2.8, post-test = 3.9), and confidence in the ability to administer NARCAN properly (pre-test = 2.4, post-test = 4.2).  

 

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. This partnership developed in April 2020, in response to the COVID-19 crisis. A total of 391 food bags and NARCAN kits have been distributed to families in need.   

 

5) UF/IFAS Extension established free nutrition education and cooking classes at Inspire to Rise, Inc. through their Expanded Food & Nutrition Education Program. Participants learned about healthy eating and cooking for less, saving money at the grocery store, food safety, and cooking and planning meals. To date, 32 residents participated in the nutrition education and cooking classes.  

 

6) Planned Parenthood partnered with Inspire to Rise, Inc. to provide the Family Life and Sexual Health (FLASH) program. This partnership provided no-cost education on HIV, other STDs, and pregnancy prevention to 8 participants and the education program will continue to be offered in the future.

 

7) Tobacco Free Duval and Northeast Florida AHEC partnered with Inspire to Rise, Inc. to provide tobacco cessation programming. 23 residents have participated in the Quit Your Way classes offered at Inspire to Rise, Inc.

 

8) Using a data driven approach, DOH-Duval partnered with Inspire to Rise to offer free walk-up COVID-19 testing to residents of 32210 and the surrounding areas. According to Florida's COVID-19 Dashboard, zip code 32210 ranked 3rd for the highest number of COVID-19 cases in the county. Through use of a mobile unit, DOH-Duval's dedicated healthcare workers tested 970 residents for COVID-19 at Inspire to Rise, Inc.

 

Implementing Duval County's CHIP in specific neighborhoods, allowed for health improvement efforts that focus on small scale efforts to build the capacity of trusted organizations. DOH-Duval will update the health profiles of Hillcrest and Hyde Park on an annual basis to continue to monitor and determine the impact of these health improvement efforts on health outcomes.

 

The Duval County 2017-2022 CHIP is a 5-year plan that identifies the public health priorities in Duval County and defines how local public health system partners will work together to improve health outcomes. The CHIP was developed through a collaborative process that included a wide range of stakeholders including local government agencies, hospitals, employers, faith-based organizations, community-based organizations, educational institutions, non-profit organizations, and advocacy groups. The place-based approach adopted for implementation of Duval County's CHIP fostered shared ownership and responsibility for the plan's implementation, while also promoting efficient and targeted collective action to improve health outcomes in priority neighborhoods. Lessons learned from adopting a place-based approach to implementation of Duval County's CHIP included:

 

1) Community partners were eager and willing to support health improvement efforts, but often needed assistance to understand their role in the MAPP process and how they can contribute to health improvement efforts.

 

2) Strategies to increase community partner engagement that focused on a discussion of needs and challenges, often lead to the identification of opportunities for collaboration that strengthened organizational and community capacity to improve health outcomes. 

 

3) Treating action plans as living documents allowed for plans to be modified as new collaborations developed and our understanding of the unique challenges and strengths of priority neighborhoods increased.

 

4) Focusing implementation of the CHIP in priority neighborhoods, rather than county-wide, allowed for more focused conversations about how partners will work collaboratively to improve health outcomes.

 

5) A strengths-based approach, that focused on identifying and building partnerships with trusted organizations, was an effective and sustainable approach to health improvement efforts. Once trusted organizations were identified, Duval County CHIP partners quickly identified opportunities for collaboration that brought needed services to residents in a location where they already access services.

 

Several steps have been taken to ensure a sustainable, adaptable, and responsive MAPP process is implemented in Duval County. These steps included:

 

1) Implementing low cost engagement activities (e.g., presentations, networking events) resulted in a sustainable MAPP process by focusing on community capacity building. Engagement strategies that focus on capacity building are more sustainable than those that focus on creating new public health interventions, programs, or services.

 

2) A place-based approach shifted the dialogue from a more general conversation about county-wide population health improvement, to a more focused conversation about improving health outcomes in specific neighborhoods. More focused conversations among CHIP partners ultimately led to the development of feasible and actionable plans to improve health outcomes.

 

3) Readily available data at the sub-county level data was used drive decision making, inform targeted action, and respond to emerging issues (e.g., COVID-19). The health profiles created for Hillcrest and Hyde Park will continue to be updated on a regular basis and used to inform, monitor, and evaluate health improvement efforts.

 

4) Implementing strategies to quickly onboard and engage new CHIP partners was critical to ensuring a sustainable MAPP process. Helping new CHIP partners understand their role early on and providing opportunities for new partners to contribute to action plans helped increased commitment to Duval County's CHIP.

 

5) In the upcoming year, rapid quality improvement (QI) projects will be conducted for select CHIP activities. These QI projects will assist with documenting successes and achieving measurable gains in public health programs being implemented in Duval County. One such rapid QI project will assess and provide resources to address burnout, compassion fatigue, and secondary trauma among peer recovery specialists implementing an emergency department program that links overdose survivors to treatment services. Integrating continuous improvement principles into the MAPP process will further the sustainability of Duval County's CHIP.

 

The place-based implementation of Duval County's CHIP will continue to help strengthen the public health infrastructure, aide and guide planning, foster collaboration, and promote the health and well-being of residents in Hillcrest and Hyde Park. As a living document, Duval County's CHIP will be reviewed and revised annually based on an ongoing assessment of the availability of resources, community readiness, current progress, and successes in improving health outcomes.