By Taylarr Lopez, Communications Specialist, NACCHO

Local health departments (LHDs) across the nation work tirelessly for the betterment of health, equity, and security for all people in their communities. Today, LHDs must develop strategic partnerships with traditional and non-traditional stakeholders that hold the power and resources to influence population health. NACCHO’s Local Health Department of the Year Award recognizes the outstanding accomplishments of LHDs across the country for their innovation, creativity, and impact on communities. The theme for the 2017 NACCHO Annual Conference was Public Health and Healthcare Linkages. NACCHO recognized four local health departments as recipients of the award at NACCHO Annual last July. This post share details about the winning LHDs’ work to cultivate strategic alliances to improve population health.

Cherokee County Public Health Department, Jacksonville, Texas (Winner in the Medium-Sized Category)

The Cherokee County Public Health Department (CCPHD) has worked tirelessly to connect its residents to healthcare services, despite facing challenges due to its rural location. Cherokee County had a nearly 40% uninsured rate, a 32% obesity rate, and high incidence of cancer. In November 2015, CCPHD set out to partner with a Federally Qualified Health Center (FQHC) to increase access to care for the under- or uninsured. Through such a partnership, the department aimed to increase the number of available healthcare providers, expand services, improve the referral network, and reduce the amount of patients lost to follow-up care.

CCPHD started the search for an FQHC partner by identifying the characteristics it was seeking, which included being fiscally sound; an established history; the use of innovative strategies; high-quality clinical outcomes; sound historical audits; and positive community presence. CCPHD then convened a small group of community members, including hospital executives, a physician, a church leader, other regional health departments, county elected officials, and select citizens to evaluate a potential partnership with two different FQHCs. In early 2016, the group selected a partner and CCPHD created a transition team to identify key logistical, legal, and funding issues. The transition required complex collaboration with community hospitals, elected officials, existing employees, the Department of State Health Services, and CCPHD’s patients.

Through the partnership, CCPHD transferred primary care, women’s health, family planning, pediatric services, and related services to its FQHC partner, Family Circle of Care (FCC); mental health and dental services will be added later this year. Additionally, this collaboration helped to launch the department’s Chronic Disease Prevention Branch, which includes new screening services and classes for diabetics.

CCPHD attributes its successful partnership to the community involvement in the decision-making process. Interim Director for CCPHD, Shannon Hitt, BSA, MBA, MPA, spoke about the collaboration: “The partnership with Family Circle of Care was in the best interest of the citizens of Cherokee County. FCC is able to provide many additional services that CCDPH was strapped to provide.”

Visiting with end-users and key community members proved to be very informative. Transparency when planning and discussing details was also crucial to the success of this partnership. Hitt further explained, “The needs of the county’s residents are very important to both CCDPH and FCC. We continue to partner, offering some of the same programs, to ensure that no one falls through the healthcare cracks. The partnership also works to connect clients with all needed services, not just medical, to care for the client as a whole.” The number of patients at the Family Circle of Care doubled in the first year of operation. CCPHD had nearly 4,000 patients during its last year of clinic operations and the FQHC saw upwards of 8,000 patients during its first year.

DuPage County Health Department, Wheaton, IL (Winner in the Large-Sized Category)

The DuPage County Health Department (DCHD) teamed up with local hospitals, healthcare providers, human service organizations, and local government to help its community residents gain access to primary care and preventive services. DCHD and its partners decided to build on existing collaborative efforts to establish multi-sectoral partnerships including (1) Impact DuPage, a county-wide initiative aimed to increase the visibility of community needs and better align resources with those needs; (2) Engage DuPage, a program that linked uninsured residents to eligible benefits and primary care providers; and (3) Ready, Set, Smile, a program that provided didactic and clinical training to dental health professionals to increase capacity in providing oral healthcare to children with special needs.

Since the inception of Engage DuPage, over 253 individuals have been linked to health department programs such as behavioral health, dental care, and STD services. Additionally, 81% of the 1,171 applications that Engage DuPage submitted for benefits — including health coverage through the federal marketplace, Medicaid, the Supplemental Nutrition Assistance Program, and Access DuPage — were approved.

Between 2014 and 2016, DCHD trained 687 dental professionals and 163 individuals through clinical sessions for the Ready, Set, Smile program, which exceeded its original targets. During this time, the program’s dental professionals provided oral healthcare treatment to 403 children with special healthcare needs. A total of 78 percent of dental professionals trained through the program reported feeling comfortable treating children with special healthcare needs and 67% incorporated the skills into their practice.

These alliances have helped uninsured residents enroll in health insurance, connect behavioral health patients to primary care, and expand the capacity of oral health providers. DCHD attributes the success of its cross-sectoral partnerships to collaborations that leverage the strengths of its partners and fulfill a need for both the system and the community. Karen Ayala, Executive Director of the DuPage County Health Department said, “The success of our alliances can be attributed to a collaboration that leverages the strengths of both partners to satisfy the needs of the community as well as the organizations.”

The health department sees relationship-building and honest conversations as the foundation of strong collaborations. Director Ayala said, “The DuPage County Health Department has a long history with community partners based upon open communication, and a commitment to developing responsive and innovative programs to improve the health of residents.” DCHD staff also notes that providing on-site patient engagement, improving reimbursement, and addressing training gaps to serve vulnerable populations strengthened the overall system and promoted sustainability.

Tarrant County Public Health Department, Fort Worth, TX (Winner in the Large-Sized Category)

The Tarrant County Public Health Department (TCPH) won this year’s award for its ongoing work to develop innovative partnerships to decrease rates of infant mortality in the county. TCPH first began assessing infant mortality data in 2001. In 2006, the department published its first Perinatal Periods of Risk assessment, which explained the risk factors for infant mortality and prematurity. TCPH worked with the Tarrant County Infant Health Network to educate the community, healthcare providers, and lawmakers about the findings of the report and viable solutions for addressing infant mortality. In doing so, TCPH established a list of objectives to lower infant mortality rates in the county: (1) add infant mortality research to TCPH’s biostatistician job description to assure that infant mortality data analysis was a priority; (2) assure that all TCPH programs addressed factors that influence pregnancy outcomes; (3) apply for available grant funding to address infant health; (4) identify the Infant Health Network as the county-wide coalition that addresses pregnancy outcomes; and (5) increase awareness of the social determinants of health among staff and across the county.

Through partnerships with the Infant Health Network, the Tarrant County Medical Society, John Peter Smith County Hospital, Cook Children’s Hospital, the Healthy Start program, and nonprofit and community organizations, TCPH has been able to effectively address the infant mortality rate by gathering data; educating the community and offering referrals to the public; implementing programs aimed to assist low-income women and increase breastfeeding rates; fostering system changes to HIV and sexually transmitted disease (STD) clinics; and affecting policy and environmental changes.

In 2008, TCPH created the Fetal and Infant Mortality Review, which engages a multi-sectoral team consisting of healthcare providers, community leaders, human services providers, consumer advocacy groups, and public health providers to review the causes and circumstances of perinatal deaths in the county. The team found that over one-half of infant deaths reviewed in the county were attributed to mostly sexually transmitted infections. Additionally, uncontrolled chronic disease, obesity, and other social determinants of health were tied to poor birth outcomes.

TCPH has since implemented a variety of programs to address the root causes of infant mortality in the county. With funding from the Texas WIC Agency, TCPH employed community health workers to educate and offer referrals to the public to help improve pre-conception and maternal health. The community health workers educated the public on a variety of topics including environmental health, domestic violence, the importance of involved fathers, nutrition and physical activity, stress management, and unhealthy behaviors.

TCPH also educated women on the consequences of prenatal smoking and second-hand smoke exposure and helped women self-manage chronic illnesses through programs including Live Tobacco Free Tarrant County and Stanford Chronic Disease Self-Management: Health for Me. It also offered a Breastfeeding Boot Camp program that provided training to clinical staff to address routine breastfeeding barriers. Finally, TCPH made systems-level changes in its HIV and STD clinics to help patients access birth control or educate them about how to have healthy pregnancies.

TCPH has made great strides in reducing infant mortality rates. Between 2005 and 2014, the infant mortality rate dropped from 8.20 to 7.22 per 1,000 live births. Among African Americans, the infant mortality rate decreased from 19.53 to 13.56 per 1,000 live births. The number of STDs reported among pregnant women has decreased from 857 to 437 from 2011 to 2015. Additionally, between December 2016 and March 2017, breastfeeding rates increased from 41% to 48%.

For other local health departments seeking to lower infant mortality rates in their jurisdictions, TCPH has four main takeaways: (1) make data-driven decisions and implement evidence-based programs; (2) collaborate with strong coalitions; (3) instill a culture of learning in the health department; and (4) welcome everyone to the table and identify shared goals.

Sonoma County Department of Health Services, Santa Rosa, CA (Winner in the Large-Sized Category)

Cardiovascular disease is the leading cause of morbidity and mortality in Sonoma County; in 2010, the disease contributed to nearly twice the burden of any other chronic condition. Risk factors for cardiovascular disease include poor nutrition, obesity, and tobacco use, which account for an estimated $570 million annually in healthcare costs.

In 2007, the Sonoma County Department of Health Services (SCDHS) convened a multi-sector coalition called Health Action that works to engage the community and partners to strategize and develop recommendations for how to address disparities and achieve health equity. SCDHS selected Health Action to pilot the Accountable Community of Health (ACH) model to improve health outcomes, reduce disparities, and lower healthcare costs by convening cross-sectoral local partners to coordinate preventive health strategies. Through the model, SCDHS sought to address cardiovascular disease, refine the infrastructure, and connect efforts to successfully pilot the ACH model so that it could be replicated in the future.

The ACH pilot program supports existing policy, systems, and environmental change, such as the Healthy Retail Program, which works with local stores to improve access to affordable, healthy foods and decrease the consumption of sugar-sweetened beverages. This work further strengthens the clinical work and bridges clinical medicine and community services.

Additionally, ACH partner organizations have conducted over 20 listening sessions with different community groups to better understand the needs of residents as they relate to cardiovascular disease. The findings will help to develop a community-wide cardiovascular disease outreach and education campaign that partners will use to raise awareness of the disease and build support for the portfolio of interventions.

Although the project is in its early stages, the initiative has built trust among clinical partners to facilitate data collection and sharing. Data from the initiative established a county-wide baseline for blood pressure control and has helped SCDHS develop an annual “report card” to track the local health system’s overall progress. SCDHS also plans to develop a process to map hypertension control data by Census track and overlay other health department data such as income, food security, parks, and proximity to a healthcare facility.

SCDHS suggests for other local health departments to think big but start small. Convening partnerships and creating consistent space for open and honest conversation are also keys to success.

All of the award winners were honored at last year’s 2017 NACCHO Annual Conference in Pittsburgh. Be sure to check out a full recap of the conference.