Innovative Health Equity Approach: Working with Human Service Organizations
Learning Objectives • Demonstrate the importance of working at the organizational level to access populations that disproportionately carry the burden of chronic disease and obesity • Explain the team process of working with organizations • Show the process of assessment, implementation and maintenance in all strategy areas of healthy eating, physical activity and tobacco-use and exposure. Importance of policy, system and environmental changes in sustaining change
PartnerSHIP 4 Health • Began in 2009 through Minnesota Department of Health Statewide Health Improvement Program funding • Work focused on schools, worksites, health care facilities and communities • Health inequities was always a focus • Identified a focus on human service organizations
Starting Point of Health Equity • As part of the Community Transformation Grant the Health Equity Initiative was started • Started with a Pilot Organization • Held focus groups of consumers and eventually staff • Awarded Competitive Statewide Health Improvement Program Innovation grant
Why the organizational level? Many organizations serve populations that disproportionately carry the burden of chronic disease. Disparate populations have higher rates of obesity and/or tobacco use and exposure, leading to high rates of chronic disease as well as experiencing health inequities.
Health Equity Populations • Individuals with low-socio economic status • Individuals diagnosed with mental illness • Individuals diagnosed with physical disabilities • Elderly • Youth • Homeless • Minority population
Why these populations? • Obesity rates for adults with disabilities are 58% higher than for adults without disabilities and for children the rate is 38% higher • Adults with disabilities are 3x more likely to have heart disease, stroke, diabetes or cancer Annual health care costs of obesity related to disability are estimated at approximately $44 billion. • The rate of smoking among adults with disabilities is 25.4% compared to 17.3%
Why these populations? • People with Serious Mental Illness die, on average, 25 years earlier than the general public • 1 in 5 adults have some form of mental illness and 36% smoke • 48% of people with mental illness who live below the poverty level smoke • It is estimated that 73% of the homeless population smokes
Why these populations? • 1/3 of the 3.7 million low-income children aged 2-4 are obese/overweight (1 of 7 are obese) • Low-income families generally have less access to both healthy food choices and opportunities for physical activity
Team Process • Dietician • Health Educator • Tobacco Coordinator • City Planner • Lactation/Breastfeeding Consultant
Recruitment • Identified organizations that serve disparate populations and prioritized • Mailed out interest letters to 48 organizations • Follow up phone call were made to organizations • 22 organizations agreed to meet to discuss partnership possibilities
Assessment • Meet with key staff • Organizations current programming • Clientele that are served • Major health issues of their clientele • Current work in key areas
Strategizing • Team discussion • Action plan completion • Possible funding opportunities • Planning towards policy, system and environmental changes • Prioritize based on readiness
Implementation • Provide action plan • Follow up meetings focused on key areas – Healthy Eating – Reducing Tobacco Use and Exposure – Physical Activity
Healthy Eating: Assessment •Are staff involved in meal choices? •What kitchen equipment is available? •Is nutrition education provided to clients? •Is there any nutrition curriculum used for education? •Is there a cafeteria/vending options available for clients? •Do you receive any donated foods for clients?
Healthy Eating: Assessment •Do your clients use food shelves? •Would clients benefit from on -site or nearby garden? •Do you purchase any local foods, such as a CSA or farmers market? •Do you have any MyPlate signage or other healthy reminders? •What would help your clients be healthier?
Healthy Eating: Recommendations •Provide education and resources for staff to assist in guiding clients to healthier food options. •Consult on healthier vending options for food and beverages •Consult regarding onsite gardening options, or connect with local food options such as CSAs or Farmers Markets •Provide healthy menu and recipe ideas for use in the facility •Assist in reviewing current policies and practices that support healthy eating in the organization
Healthy Eating: Successes CCRI, Moorhead - University of MN Extension “Let’s Cook” class for staff
Healthy Eating: Successes “I will plan healthier meals for my clients and will cook with more confidence” - an attendee from Let’s Cook class
Healthy Eating: Successes Access of the Red River Valley, Moorhead - Raised bed gardens
Healthy Eating: Successes West Central Regional Juvenile Center, Moorhead -Gardening project for youth
Tobacco Use & Exposure: Assessment • Is there currently a tobacco-free policy? • Are there signs that communicate a policy? • Is the policy enforced? Are there challenges?
Tobacco Use & Exposure: Assessment • Are clients connected to cessation services? – Onsite classes, phone based counseling, etc. • Are staff allowed to smoke with clients? – Purchase tobacco for clients? • Are there receptacles on the property? • Is there e-cigarettes being used by clients? – Where?
Tobacco Use & Exposure: Recommendations • Updating Policies
Tobacco Use & Exposure: Recommendations • Updating Forms
Tobacco Use & Exposure: Recommendations • Implementing Educational Resources
Tobacco Use & Exposure: Recommendations • Provide positive messages, posters, etc.
Tobacco Use & Exposure: Recommendations • Placement of signage • Provide signage
Tobacco Use & Exposure: Recommendations • Promote quit resources – Health plans, QuitPlan, etc. • Promote quit medication • Are there success stories for other employees to hear? – If so make sure to share them!
Tobacco Use & Exposure: Success Stories • Lakeland Mental Health Center in Moorhead – Received a Carbon Monoxide meter • Using that with ARMHS clients • Had 1 staff member quit smoking after using the CO monitor – Now working on updating policy
Tobacco Use & Exposure: Success Stories • Compassion House in Detroit Lakes – Attended our 1 st Dr. Jill Williams training in 2013 – Using a Carbon Monoxide meter with residents • Now looking to start a group after attending follow-up training – Updated policy to become tobacco-free • Staff not providing or transporting clients
Tobacco Use & Exposure: Success Stories • CCRI – Added Nicotine Addiction on the Axis 1 Diagnosis • Placing in treatment plans
Physical Activity: Assessment • How much and what type of physical activity do clients get? • Do staff incorporate physical activity with clients? • Are membership discounts available to clients or do they have access to equipment? • Are surrounding areas conducive to walking/biking?
Physical Activity: Assessment • Are questions incorporated into needs/interest assessments? • Do clients use transit? • Are bikes available? • Is a bike rack available? • What would help you help your clients be more physically active?
Physical Activity: Recommendations • Provide input on options or potential opportunities to create an environment/system that integrates increased physical activity • Education and resources to staff that assist in purchasing, preparing and/or guiding clients to increased physical activity • Consult on low cost, east to use resources for physical activity
Physical Activity: Recommendations • Work with staff to introduce ideas for physical activity with clients • Provide review and assist with health education resources that includes physical activity • Review current policies and practices and/or assist in developing policies and practices that support physical activity
Physical Activity: Successes West Central Regional Juvenile Center – Active Recess Consultants “This has led to an increase in self -esteem and opportunities for learning skills that they can take away from their program.” -Stephen Larson, WCRJC Director
Physical Activity: Successes Access of the Red River Valley
Physical Activity: Successes
Physical Activity: Successes A Place 2 Belong “Walking provides a simple physical outlet for individuals with mental illness and assists in emotional and mental wellbeing.” -Sue Wilkin, AP2B Director
Other Areas • Lactation/Breastfeeding Support • Worksite Wellness
Evaluation • Meet on quarterly basis with partners • What kind of policy, system and environmental change is being made • What is the result of the policy, system and environmental change • Next steps
Contact Information Corey Ernst corey.ernst@co.clay.mn.us (218) 299-5063 Keely Ihry keely.ihry@co.clay.mn.us (218) 299-7180 Dana Rieth drieth@lcsc.org
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