Merced County Community Health Improvement Plan

Merced County Community Health Improvement Plan

2017 - 2022


Table of Contents

Executive Summary……………………………………………………………………………………………………………………………..….3

Acknowledgements…………………………………………………………………………………………………………………………………4

Section 1: Background, Context, and Results..………………………..….…………....................................................5

Section 2: Planning for Success.……………………………………………………………………………………………………………....9

Section 3: Community Engagement Approach……………………………………………………………………………………....13

Section 4: Ranked Health Priorities……………………………………………………………………………..……………………….. 22

Section 5: Summary of Community Discussions on the Health Priorities ...……..…………………………………….24

Section 6: Introduction to the Work Plan - Goals, Objectives, & Strategies………………………….…..…………...30

Work Plan…………………………………………………….……………………………………………………………………...31

Appendices…………………………..………………………………………………………………………………………………………………. 45

Appendix A: Community Engagement Handouts………………………………………………………………...46

Appendix B: List of Community Outreach………………………….…………………………………………………48

Appendix C: Top Health Priorities from Community Meetings ……………………………..…………….49

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Executive Summary

Through collaborative efforts with community partners, the Merced County Department of Public Health has developed the Merced County Community Health Improvement Plan (CHIP) which will serve as a blueprint for collective action to address health disparities and to promote health equity with the goal of health and wellness for all county residents.

Health and wellness cannot be realized through medical care alone. Quality, accessible medical care is an important component of a healthy community and is identified as one of the CHIP’s top three health priorities. But, the framework to achieve health and wellness must also be present at home, in neighborhoods and communities, at work, and at school.

To build that framework, the social determinants of health – safe, violence-free environments, affordable housing, adequate education and training, and a broad base of livable-wage employment opportunities - must be available. Health and wellness can be attained only when all residents have an equal chance to lead healthy lives regardless of race, ethnicity, sexual orientation, gender identity, socio-economic conditions, or immigration status.

The CHIP’s work plan is meant to support a variety of actions by a wide range of partners. With a focus on policy, systems, and environmental strategies, the work plan’s intent is to establish and strengthen factors that influence health and wellness in our community.

The Merced County Community Health Improvement Plan reflects the engagement and efforts of many community residents and organizational partners in their ongoing work to improve health and wellness for all Merced County residents.

Thank you for your commitment to making Merced County a healthy place for all. Kathleen Grassi, RD, MPH Director Merced County Department of Public Health February 17, 2017

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Acknowledgements The development of the Merced County Community Health Improvement Plan was accomplished through the contributions of many. In addition to those who are acknowledged below, I want to sincerely thank the many Merced County residents who participated in community meetings, visited our “traveling booth” and helped us to identify the health priorities found herein. Dedicated organization partners formed the Accreditation External Task Force which was charged with developing, reviewing, and commenting at all stages of the CHIP development. Members of the Task Force represented the following organizations: • Building Healthy Communities, Merced • Livingston Community Health

• Central California Alliance for Health • Merced County Department of Behavioral Health and Recovery Services

• Dignity Health Mercy Medical Centers Merced • Merced County Department of Public Health

• First 5 Merced County • Sutter Health Memorial Hospital Los Banos

• Golden Valley Health Centers • United Way Merced County

• University of California, Merced

Resource Development Associates, a California-based consulting firm, was retained to assist the Task Force members in the formulation of materials and messaging that formed the backbone of the CHIP community engagement process. RDA was also instrumental in describing the activities and results of the community engagement process, as well as the collaborative strategy sessions, incorporated in this document. The photographs of Merced County residents, which were used on the front and back covers of the CHIP, were taken by Kara Brodgesell, Photographer. Finally, I want to acknowledge Merced County Public Health Department staff who have been engaged in every aspect of the CHIP – from the vision to the plan – and who, with many community partners, will take this plan into action. For more information on the CHIP and current implementation efforts, contact: Kristynn Sullivan, Epidemiologist and Accreditation Coordinator at [email protected] 209-381-1200.

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mailto:[email protected]


Section I. Background, Context, and Results

The Merced County Department of Public Health (MCDPH) is dedicated to protecting and improving community members’ health and long-term wellbeing. In order to better understand and meet the County’s diverse health needs, MCDPH, in collaboration with an Accreditation External Task Force of community partners, completed a Community Health Assessment (CHA) to provide an overview of the county’s health status and leading health concerns. This CHA was produced through a two-year process of data collection and analysis, supplemented by key informant interviews, and a random-digit-dial survey of residents gleaned from local hospital community health assessments.

Using the CHA as a starting point, MCDPH carried out a community engagement process to develop strategies to address countywide health issues though a Community Health Improvement Plan (CHIP). The CHIP will be used by a range of community agencies and organizations, in partnership with MCDPH, to roll-out CHIP strategies. The CHA and CHIP are also prerequisite documents for MCDPH to be eligible for accreditation through the National Public Health Accreditation Board (PHAB).

Section 1 of the CHIP describes MCDPH’s planning approach to ensure success. Section 2 describes the community engagement activities, including the facilitation process used to guide community stakeholders in the selection of priority health issues, along with a summary of meeting locations and participant characteristics. Section 3 presents the ranked health priorities that emerged from the community engagement process. Section 4 synthesizes the themes that arose in the community discussions around health priorities in Merced County. Section 5 presents the CHIP goals, objectives, and strategies developed through planning sessions with MCDPH and community partners.

Merced County Department of Public Health

Vision

Merced County: A healthy place for all.

Mission

To promote, protect, and preserve healthy living and safe environments.

Values

Equity: Recognizing disparities and having a purposeful commitment to improve social conditions.

Innovation: Creative, data-driven solutions that make a difference.

Integrity: Honest, respectful, and non-judgmental with high ethical standards.

Leadership: Trusted key partner, creating change through inclusive collaboration.

Quality: Promoting, expecting, and maintaining excellence through an expert workforce.

Responsiveness: Agile and able to adapt to community needs.

Service: Committed to beneficial system change, education, advocacy, and prudent regulation.

Stewardship: Responsible and transparent management of resources.

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http://www.co.merced.ca.us/DocumentCenter/View/12213


Through collaborative efforts with community partners, MCDPH strives to make Merced County a safer and healthier place for residents to live, work, and play. MCDPH understands that health and wellness cannot be realized by medical care alone. Instead, health and wellness begins in our homes, neighborhoods and workplaces, in our school systems, and at our community parks and playgrounds. Keeping this in mind as an organizing principle to move towards a healthier community, the CHIP intentionally incorporates strategies around the broader social and environmental issues that impact the public’s health.

Factors that contribute to health inequities in Merced County include, but are not limited to, low educational attainment and high rates of unemployment; poverty; and inequitable access to healthy foods, safe public spaces, and adequate housing. Additionally, health disparities that are seen among racial, ethnic, and marginalized social groups point to underlying systemic biases that constitute a root cause of poor health outcomes. Using the Community Health Assessment as a foundation, and ensuring community engagement in the development of the CHIP, MCDPH implemented a process to bring forth strategies which move beyond interventions that target individual health behaviors to strategies addressing the underlying factors that affect the community’s health.

Each objective outlined in the CHIP incorporates one or more of the identified socio-environmental concerns and provides an upstream or policy level intervention to promote equity and quality of life for all of Merced County’s residents.

Focus on Health Equity and the Social Determinants of Health

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Community Health Assessment – 2014 - 2016

Community Health Improvement Plan – 2016 - 2017

January 2014 to

May 2016

June to August 2016

September to October 2016

November to December

2016 January

2017

Developed Community Health

Assessment

Identified Priority Health Issues

Held 15 CHIP Community Meetings across Merced County

Participated in 14 Traveling Booth

Events across Merced County

Conducted 3 Participatory Strategy

Sessions with Community Partners

Refined Goals, Objectives, and

Strategies

Finalized Community Health Improvement Plan


Development Timeline

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Priority Area 1: Access to Health Care Goal: All individuals in Merced County have access to quality health care.

•Objective 1.1: Increase the number of health care providers, in all fields, in Merced County. •Objective 1.2: Ensure comprehensive, culturally responsive, and quality health care for all. •Objective 1.3: Build data repository and data sharing resources across systems of care to increase continuity

and quality of care. •Objective 1.4: Create community-based health support services intended to enhance clinical care. •Objective 1.5: Support integration of primary care and behavioral health within the health care system.

Priority Area 2: Preventable Chronic Diseases: Heart Disease, Stroke, and Diabetes Goal: Merced County will optimize the social and physical environments to support healthy lifestyles and reduce the risk of chronic disease for all residents.

•Objective 2.1: Address policy, system, and environmental factors intended to promote and improve community health. •Objective 2.2: Increase community access to social networks and support systems to reduce and manage

preventable chronic diseases. •Objective 2.3: Increase culturally appropriate health education opportunities for Merced County’s diverse

populations. •Objective 2.4: Increase provider participation in preventative marker identification and referral to culturally

appropriate community support systems.

Priority Area 3: Substance Abuse Goal: Increase wellness in Merced County by addressing the conditions that lead to drug and alcohol abuse.

•Objective 3.1: Increase treatment capacity and accessibility to substance abuse resources. •Objective 3.2: Develop practices and policies to encourage prevention rather than punishment of substance

abuse, and promote treatment and recovery. •Objective 3.3: Invest in youth to decrease and prevent substance abuse and provide alternatives to

substance use. •Objective 3.4: Educate and engage community members and stakeholders around factors that contribute to

the initiation and perpetuation of substance abuse (e.g. ACEs). •Objective 3.5: Support Housing First and other sober living efforts, co-located with substance abuse

prevention and treatment programs, to create stable environments for the homeless.

Priority Area 4: Health Equity and Social Determinants of Health Goal: All residents in Merced County will have equal opportunities to lead healthy lives, regardless of race, ethnicity, sexual orientation, gender identity, income level, education, or employment status.

•Objective 4.1: Build and maintain partnerships with a broad base of community sectors (e.g., faith-based, schools, residents, etc.). •Objective 4.2: Decrease poverty and increase literacy and education, and employment opportunities. •Objective 4.3: Improve the built environment to provide health-promoting community places for all. •Objective 4.4: Identify and address health disparities and promote health equity for all in Merced County.

Merced County Community Health Improvement Plan At-A-Glance

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Section 2: Planning for Success

In order to ensure the inclusion of Merced County’s diverse populations, MCDPH developed a strategy to involve many stakeholders and communities in the community health improvement planning process. MCDPH used a process adapted from Mobilizing for Action through Planning and Partnerships (MAPP), a community-wide strategic planning process designed by the National Association of County and City Health Officials (NACCHO) to improve public health.1 MCDPH followed the six general steps of the MAPP framework, illustrated in Figure 1 and described in detail below.

Figure 1. CHIP Development Approach

1 NACCHO. September 2013. Mobilizing for Action through Planning and Partnerships (MAPP): User’s Handbook.

Organize for Success •Develop partnerships •Secure consultant contract

Visioning •Focus on social

determinants of health and health equity

Assessment •Collect, analyze, and report

health-related data (CHA)

Identify Strategic Goals •Conduct community

engagement and prioritization process

Formulate Goals and Strategies

•Hold participatory strategy sessions

Action Cycle •Undertake continuous

planning, implementation, and evaluation

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1. Organize for Success. In early 2014, MCDPH convened a task force of community partners to start the process of developing the CHA and the CHIP. This Accreditation External Task Force met monthly to discuss topics related to community health assessment and improvement. The Accreditation External Task Force developed the scope of work for a vendor to take the results of the CHA, when completed, to the community for discussion, facilitate a process for the community to prioritize the health concerns identified in the CHA, and summarize these findings in a CHIP. MCDPH contracted with Resource Development Associates (RDA), a California-based consulting firm, to assist with these tasks.

2. Visioning. In this step, MCDPH and the Accreditation External Task Force developed a vision for the project that focused on health equity and social determinants of health, in alignment with MCDPH’s emphasis on addressing structural factors influencing health. This approach was selected after a countywide pattern of high mortality rates paired with low prevalence rates was identified across several health conditions. Rather than indicating true low prevalence, this suggests that Merced County residents, in particular within communities of color, are diagnosed at later stages of disease, leading to higher mortality rates. As a result of this visioning process, the CHA included not only physical health conditions, but also focused heavily on broader environmental factors such as income, education, employment, housing, and violence.

3. Assessment. To develop the CHA, MCDPH gathered both quantitative and qualitative data on the community’s health status through a two-year process of data collection and analysis, which included publicly available population data as well as survey and interview data collected by Professional Research Consultants (PRC) for Dignity Health’s 2015 Community Health Needs Assessment. While the development of the CHA was spearheaded by MCDPH, several drafts were presented to the Accreditation External Task Force for review and discussion. The CHA was finalized and made publicly available in 2016.

4. Identify Strategic Goals. Using the CHA, MCDPH developed a community engagement process to determine the strategic issues that should be addressed in order to improve health and wellness in Merced County according to the Accreditation External Task Force’s vision. Considering prioritization criteria developed by NACCHO, including size of the issue, seriousness of the issue, trends over time, demographic disparities, and feasibility and resources, Task Force members prioritized the broad sections of the CHA (e.g., Leading Causes of Death, Mental Health, Infectious Disease, etc.) and the chapters within each section (e.g., Heart Disease, Diabetes, Depression, etc.). Rankings were

Accreditation External Task Force Members

• Building Healthy Communities, Merced • Central California Alliance for Health • Dignity Health Mercy Medical Centers

Merced • First 5 Merced County • Golden Valley Health Centers • Livingston Community Health • Merced County Department of Behavioral

Health and Recovery Services (formerly the Mental Health Department)

• Merced County Department of Public Health • Sutter Health Memorial Hospital Los Banos • United Way-Merced County • University of California, Merced

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averaged, and priorities from the top rankings of each major section were selected (i.e. at least one topic was chosen from each major section). The Accreditation External Task Force vetted the final selections and determined the following 10 priority areas to bring to the community for further discussion and prioritization. (See Section 3 for details on the community engagement process.)

Health Conditions Social Determinants of Health

Hearth Disease and Stroke Access to Care

Chronic Lung Disease Income, Education, and Employment

Diabetes

Healthy Foods and Physical Activity

Drug and Alcohol Abuse Injury and Violence

Sexually Transmitted Diseases Housing and Homelessness

5. Formulate Goals and Strategies. After an extensive countywide community engagement process in July and August 2016, MCDPH held three participatory strategizing sessions in September and October 2016 with community partners including members of the Accreditation External Task Force, the Merced County Health Care Consortium and other organizations to assure broad representation.

In September, participants split into workgroups based on each of the identified health priority areas and used an interactive and sequential process of developing a goal statement, four to six

CHIP Strategy Session Participating Agencies – September 22, 2016 Session

• Franklin-Beachwood Committee for Improvement

• BHC Health Equity Project

• Building Healthy Communities, Merced

• Central California Alliance for Health

• City of Gustine

• Dignity Health Mercy Medical Centers Merced

• First 5 Merced County

• Golden Valley Health Centers

• Livingston Community Health

• Merced County Behavioral Health and Recovery Services

• Merced County Board of Supervisors

• Merced County Department of Public Health

• Merced County Human Services Agency

• Merced County Office of Education

• Merced County Sheriff's Department

• Sutter Health Memorial Hospital Los Banos

• The California Endowment

• University of California Merced

• University of California Merced-Blum Center for Developing Economies

February 2017 | 11


objectives for each goal, and up to three strategies for each objective. MCDPH then met with the External Task Force on October 27, 2016 to validate and refine the goals and objectives.

Also, on October 27, 2016, there was a strategy session with members of the Merced County Health Care Consortium. The Consortium membership includes 91 e-list invitees from local hospitals, county departments (public health, human services, and behavioral health), health plan organizations (Medi-Cal Managed Care plan, Covered CA and one of its plans, Blue Cross), safety net clinics, community-based organizations, educational institutions, representatives from state and federal elected officials’ offices and interested non-affiliated individuals.

Participants again split into groups based on the health priority areas and brainstormed strategies for policy, system, and environmental changes that would need to be in place to support the CHIP’s goals and objectives.

Following the strategy sessions, MCDPH refined the goals, objectives, and strategies to ensure the CHIP maintained a focus on social determinants of health and reflected a comprehensive plan of action with strategies in the following categories:

CHIP Strategic Action Categories Partnerships Evaluation

Communication Assessment

Policy Development/Implementation Youth/Adult Engagement

Resource Development Stakeholder/Consumer Education

Practice Enhancement Other 6. Action Cycle. Following the development of the CHIP, MCDPH and its community partners will

undertake continuous planning, implementation, and evaluation to ensure that the community achieves the goals set out in the CHIP.

MCDPH is also engaged in a concurrent strategic planning effort, through a Quality Oversight Group, which will develop action plans for the strategies identified in the CHIP that will guide the Department’s efforts over the next five years.

The CHIP will inform new and ongoing collaborative efforts such as a coalition to address health equity co-facilitated by the Merced County Departments of Behavioral Health and Recovery Services and MCDPH (new); ongoing collaborations to address preventable chronic diseases through MCDPH’s Partnerships to Improve Community Health and Merced County Accountable Community For Health (ongoing); and cooperative efforts to improve access to health care as well as quality health care delivery through MCDPH’s Whole Health Partnership and Merced County Accountable Community For Health efforts (ongoing).

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Section 3: Community Engagement Approach

To ensure that a broad representation of county residents had an opportunity to contribute to the CHIP, MCDPH planned a series of community meetings and identified outreach events where the top 10 health conditions and social determinants of health issues from the CHA would be presented.

MCDPH contracted with RDA to develop visually appealing graphics and materials depicting the 10 priority health issues. RDA created representative icons for each health issue to allow for quick and easy identification by community members, taking into account concerns about literacy and cultural differences among Merced County’s diverse residents (see example in Figure 3 and full materials in Appendix A). RDA then developed PowerPoint presentations for the community meetings. MCDPH and RDA used these materials to facilitate the prioritization of health issues at two types of community engagement events: 1) community meetings; and 2) a traveling booth. Each of these approaches is described below.

Merced County Community Health Improvement Planning Session October 27, 2016

Figure 2. CHIP Participatory Strategy Sessions - September and October 2016

Merced County Community Health Improvement Planning Session September 22, 2016

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Community Meetings

MCDPH had three objectives for the community meetings:

1. Report out on the main findings from the CHA and connect the findings’ relevance to community health status.

2. Engage community members in a prioritization of health issues to be included in the CHIP through a voting activity.

3. Gather information about resources and strategic ideas to address

the priority health issues as documented in the CHIP.

To achieve these objectives, the MCDPH used a PowerPoint presentation that summarized and presented the data from the CHA, dividing the information into two sections: 1) health conditions; and 2) social-environmental health concerns (see example slide in Figure 4 below). Facilitators from RDA and MCDPH encouraged participants to ask questions about the data presented and to share their experiences related to the 10 priority issues.

Figure 4. Example of Presentation of CHA Data

Figure 3. Example of Materials

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Next, participants had the opportunity to vote for their first and second priorities in each section: health conditions and social determinants of health. The facilitators used an electronic voting tool, iclicker, to allow for an interactive and real-time voting process. (see Figure 5).

Figure 5. Voting Exercise with iclicker

Following the voting activity, the facilitators led a discussion about: 1) services and resources that currently exist or could be expanded upon to effectively address the priority health issues; and 2) services and resources that do not exist but would be beneficial in addressing the priority health issues.

Through the community meetings, MCDPH aimed to gather feedback from stakeholders at various locations across the widespread geographic area of Merced County, as well as from vulnerable populations and the county’s major ethnic communities. For geographic representation, MCDPH held one or two meetings in each of the five county supervisorial districts. Additionally, five population-specific meetings and two meetings with health care professionals were also held (see Figure 6 below).

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Figure 6. Map of Community Meetings by Supervisorial District

Most meetings were held in English, with simultaneous Spanish-language interpretation available. A meeting was co-facilitated in English and Punjabi in a community with a large Punjabi-speaking population. A meeting was also conducted in Hmong for Hmong community representatives. In the Punjabi and Hmong meetings as well as with members of an African-American church congregation, MCDPH partnered with identified community leaders to facilitate the meetings in a culturally responsive way.

Table 1 below shows the district and population-specific meetings along with the number of meeting participants. Based on attendance sign-in sheets, a total of 251 people participated in 15 community meetings.

Merced County Board of Supervisors

2016

District 1 – John Pedrozo

District 2 – Hub Walsh

District 3- Daron McDaniel

District 4 – Deidre Kelsey

District 5 – Jerry O’Banion

Community Health Improvement Plan 2016 Community Meetings

Dos Palos

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Table 1. Community Meetings and Number of Participants 15 Meeting Locations Number of

Participants District Meetings District 1 Planada (Spanish/English) Livingston (Punjabi/English)

15 30

District 2 City of Merced

16

District 3 Atwater Franklin-Beachwood

10 13

District 4 Winton Gustine

12 9

District 5 Los Banos

7

Population-Specific Meetings Latino/Hispanic (Spanish/English) 18 Monolingual Hmong 34 Transitional Age Youth (18 to 24 yrs of age) 15 LGBTQ 6 African American Church members 21 Health Care Consortium 30 Department of Public Health staff 15 Total 251

Outreach Strategy

Using flyers and email templates (see example in Figure 7), MCDPH and RDA conducted outreach through a number of media outlets (e.g., newspapers, online calendars), community-based organizations, and staff members from county and city agencies. Community leaders in the Hmong and Punjabi communities also conducted outreach to their communities. Building Healthy Communities, Merced played a large outreach role in several of the communities. A full list of outreach contacts is presented in Appendix B.

When MCDPH was able to partner with a community leader to reach specific communities, turnout at the community meetings was enhanced. Moving forward, MCDPH plans to identify community liaisons and develop a handbook of local resources (i.e., Facebook pages) and contacts in order to support future outreach efforts.

Figure 7. Outreach Flyer

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Thirty-six percent of community meeting participants was Latino, followed by 25% Asian, 20% White, and 12% Black. There was a higher percentage of Asian participants in the community meetings (25%) than live in Merced County (7%) and a smaller percentage of Latino participants in the community meetings (36%) than live in Merced County (56%). There was a slightly lower percentage of white participants in the community meetings (20%) than live in Merced County (31%) and a slightly higher percentage of black participants in the community meetings (12%) than live in Merced County (3%) (see Figure 8).

Figure 8. Race/Ethnicity of Community Meeting Participants Compared to Merced County

County data from Census ACS 2014 population estimates. Community meeting data from 201 participants (of 251 voting participants). Seven percent of community meeting attendees reported their race as mixed or as other than the listed categories.

A range of age groups was represented at community meetings, with the highest percentage of participants between 35–54 (28%) and the lowest percentage of participants between the ages of 25–34 (10%). Compared to the population of Merced County, community meeting participants were slightly older. Though only 19% of County residents are 55 years old or older, 45% of community meeting participants was within this age range (see Figure 9).

31%

3% 7%

56%

20%

12%

25%

36%

0%

10%

20%

30%

40%

50%

60%

White Black Asian Latino

Merced County Community Meetings

February 2017 | 18


Figure 9. Age of Community Meeting Participants Compared to Merced County

County data from Census ACS 2014 population estimates. Community meeting data from 206 participants (of 251 of voting participants).

When asked their level of educational attainment, almost a quarter of community meeting participants reported they had not completed high school, slightly over a quarter reported a high school diploma or GED, and 44% reported an associate’s degree or higher. Community meeting attendees had higher levels of education than the population of Merced County: 31% of community meeting attendees had a bachelor’s degree or higher, compared to only 13% of Merced County residents (see Figure 10).

Figure 10. Level of Education of Community Meeting Participants Compared to Merced County

County data from Census ACS 2014 population estimates of population 25+ years old. Community meeting data from 203 participants (of 251 of voting participants). An additional 8% of community meeting attendees had vocational/trade certificates or degrees.

12% 14%

24%

9% 10%

17%

10%

28%

22% 23%

0%

5%

10%

15%

20%

25%

30%

18-24 25-34 35-54 55-64 65+


32%

25%

7%

13%

22%

26%

13%

31%

0% 5% 10% 15% 20% 25% 30% 35%

Less than high school

High school or GED

Associate's degree

Bachelor's degree or higher


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Traveling Booth

In order to gather feedback from as many diverse community members as possible, including hard-to-reach populations in more remote locations, MCDPH set up a “traveling booth” at 14 community events and locations throughout the County (see text box below). At each location, the community engagement materials depicting the 10 health issues were presented in English and Spanish on large posters and on handouts for community members. MCDPH representatives staffed the booth and were available to answer questions and provide additional information about the health issues.

Figure 12. Community Meeting in Planada, July 12, 2016

Figure 11. Community Meeting in Livingston, July 26, 2016

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Each of the 10 health issues was presented on a box, into which community members could place a token to vote on what they believed to be the health issue that matters the most in their community. Community members received a small incentive (e.g., flashlight, water bottle, or pen) for voting. In total, the booth activity garnered 2,313 votes.

Traveling Booth Locations Atwater Mental Health Stigma Reduction Event

Los Banos Flea Market

Atwater School Lunch Program (Parents)

Los Banos Miano Elementary Lunch (Parents)

Castle Family Health Centers Health Fair Event

Los Banos National Night Out

Castle Head Start

Los Banos United Methodist Vacation Bible School

Gustine 5k Color Run

Merced County Fair

Livingston Farmers Market

Merced Mental Health Stigma Reduction Event

Livingston 4th of July Festival

Public Health Department

Figure 13. CHIP Traveling Booth

Merced County Fair: Nancy Young, Special Projects Coordinator; Kathleen Grassi, Public Health Department Director; Tim Livermore, Health Officer; and Hortensia Silva, Community Health Specialist.

Los Banos Flea Market: Kristynn Sullivan, Epidemiologist and Accreditation Coordinator.

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Section 4: Ranked Health Priorities

A tally of the votes collected across the 15 community meetings and the 14 traveling booth locations revealed community members’ health priorities. Figure 14 displays the number of votes each health issue received across all community meetings, and whether the issue was voted as the first or second priority. Adding the total number of votes, including participants’ first and second top priorities, the top five priority areas were: Income, Education, and Employment; Heart Disease and Stroke; Diabetes; Access to Health Care; and Drug and Alcohol Abuse (see

Appendix C for priority votes from individual meetings).

Figure 14. Community Meeting Votes by Health Issues

Table 2 lists the total votes received by each health issue at the traveling booth.

Table 2. Tally of Traveling Booth Votes by Health Issue

Health Topic Number of Votes Income, Education, Employment 438 Alcohol & Drug Abuse 433 Housing & Homelessness 329 Diabetes 276 Injury & Violence 203 Healthy Food & Physical Activity 190 Access to Medical Care 160 Heart Disease & Stroke 109 Sexually Transmitted Infections 91 Chronic Lung Disease 74 Overall Total 2,313

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1

6

1

2

7

13

1

1

2

2

4

4

9

8

5

2

SEXUALLY TRANSMITTED INFECTIONS

INJURY & VIOLENCE

HOUSING & HOMELESSNESS

CHRONIC LUNG DISEASE

HEALTHY FOODS & PHYSICAL ACTIVITY

DRUG & ALCOHOL ABUSE

ACCESS TO CARE

DIABETES

HEART DISEASE & STROKE

INCOME, EDUCATION, & EMPLOYMENT

First Priority Second Priority

(15)

(12)

(10)

(10)

(10)

(5)


To further refine the community’s ranked list of health issues, MCDPH and the Accreditation External Task Force developed a framework to collapse related health issues into one category and pair top voted social and economic determinants where they overlapped with a health condition. For example, community meeting participants voted both Heart Disease and Stroke and Diabetes as important heath conditions. Given that these diseases have similar risk factors, indicators, and intervention strategies, these health conditions were combined into a single priority area: Preventable Chronic Diseases: Heart Disease, Stroke and Diabetes. When discussing these diseases, community members consistently talked about the importance of access to healthy foods and safe places to exercise—connecting Preventable Chronic Diseases to the Healthy Foods and Physical Activity social determinant of health.

Nearly every meeting discussed Drug and Alcohol Abuse, and it received the second highest number of votes among the health conditions presented for prioritization at the community meetings. Based on community members’ discussions, one socio-economic factor that closely related to Drug and Alcohol Abuse, (re-titled as Substance Abuse), was Housing and Homelessness.

Community members also voted Access to Care as a top issue and discussed this matter in relation to every health condition; therefore, MCDPH included this issue as a priority to be strategically addressed in the CHIP. Income, Education, and Employment received the highest number of votes from both the community meetings and traveling booth voting. Due to high community significance, this social determinant of health was incorporated as an overarching issue to understand and better address all of the identified health concerns in the CHIP.

In addition, disparities were evident in discussions about health care access, cultural responsiveness and discrimination in health care settings due to race/ethnicity, sexual orientation, or language spoken. Disparities in health status emerged as underlying issues impacting the health of many communities in Merced County. As such, the CHIP also includes Health Equity as a cross-cutting factor influencing each of the health priority areas.

Figure 15 displays the three priority areas in combination with their respective socio-environmental factors.

Figure 15. Top Three Health Priorities and Corresponding Socio-Environmental Factors

Health Equity Access to Health Care

Substance Abuse

Preventable Chronic Diseases: Heart Disease,

Stroke, and Diabetes

Income, Education,

Employment

Healthy Foods and Physical Activity

Housing and Homelessness

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Section 5: Summary of Community Discussions on the Health Priorities

This section summarizes the community discussion around the top three ranked health priorities and corresponding socio-environmental factors. Community members often shared their personal experiences, or family members’ experiences, of how these priority health issues have impacted their lives. The meeting discussions largely aligned with the voting results listed previously; however, participants placed particular emphasis on additional issues they viewed as relevant to the health and wellbeing of their community. The text box below highlights some of the key takeaways from these discussions.

Key Takeaways from Community Meeting Discussions

Need for medical care and services

Community members highlighted challenges in getting the medical care they needed because of limited or non-existent programs or providers.

Challenges accessing care Residents experienced barriers to accessing care related to cost, transportation to facilities, high wait times for an appointment, and insufficient information about services available. Some community members observed a culture of not seeking care.

Dissatisfaction with care Community members shared experiences of discrimination and care that was not culturally relevant.

Safe community spaces Community members did not view parks in their communities as safe, and children faced barriers to playing in parks, such as when bathrooms are locked or not available at all.

Access to healthy foods Community members perceived their neighborhoods as food deserts. Some participants recommended community gardens and accepting food stamps at farmers markets.

Behavioral health concerns The community as a whole emphasized concerns about substance abuse and mental health issues.

Injury and violence Car accidents due to unsafe driving and gang violence were not reflected as priorities by the voting exercise, but emerged in discussions.

Insufficient income Many families struggled with meeting their basic needs such as food and shelter.

Community centers and information exchange

Many participants expressed the desire for venues and opportunities for local residents to come together to build community and learn about health topics and resources.

February 2017 | 24


Access to Health Care

Community meeting participants across all districts and population-specific groups expressed numerous challenges in accessing the various types of health care services and programs they need. Since the rollout of the Affordable Care Act, more people in Merced County have health care coverage; however, according to community participants, many people remain uninsured, specifically Merced’s undocumented adults. Participants stated that undocumented residents experience disproportionate challenges in getting the care they need. Additionally, even insured residents are not having their medical needs met. Residents reported struggles with the cost, availability, location, quality of care, and wait time for services. Participants in the Health Care Consortium community meeting voiced that there continues to be an extremely high utilization of emergency services for primary care needs, as well as a shortage of all types of health care providers across the county. A summary of the barriers to care most frequently mentioned in the community meetings follows.

Many community members stated that there is not enough primary care, specialist, or mental health providers to adequately serve their community. Some attributed the shortage of doctors and health care providers in general to challenges with retention and noted that, currently, many providers are retiring at a high rate.

The availability of mental health providers and services, especially counseling services, was of particular concern in most population-specific and several district community meetings. One community participant expressed frustration about the need for more services and observed that many who seek care in a hospital setting would be better served by targeted mental health treatment.

Additionally, many community members identified issues of drug and alcohol abuse as well as injury and violence as important health concerns related to the perceived lack of access to mental health care services and the limited availability of providers.

Multiple community meetings discussed strengthening the University of California, Merced medical education track to create a strategic career pipeline of medical professionals to serve the community from within and address the shortage of physicians.

Participants in Districts 1, 2, 3, and 5 and all population-specific group participants stated that cost was a major barrier to obtaining medical services. Many described financial challenges

“Income and unemployment is a major problem in our community; people don’t come to the hospital because of the bill—they can’t pay it.”

-Franklin-Beachwood Community Meeting Participant

“We need more help with mental health problems - they don’t need to go to the hospital, but they need mental health treatment. Often people stay in the hospital and there is no mental health evaluation there, so they sit there.”

–African American CommunityMeeting Participant

February 2017 | 25


making it difficult to meet their basic needs and impeding their ability to pay for medical care, even when medical services are offered on a sliding scale.

Meetings in all districts discussed concerns with transportation. For some, not having access to a car made it difficult for them to get to medical appointments. Additionally, participants mentioned having to travel great distances to seek out services they needed because those services are not available in their immediate area or even within Merced County. Many voiced spending a whole day on one appointment, including traveling to the doctor and then waiting to be seen. One participant also described this challenge related to accessing mental health treatment.

At almost all of the population-specific community meetings, participants mentioned experiencing discrimination during their health care interactions and in the community at large, or described a friend or family member’s experiences with discrimination. Community members shared experiences of being discriminated against based on their race, ethnicity, or sexual orientation in medical settings. Participants noted that ongoing discrimination decreases the likelihood that they will seek care, and causes them to lose confidence in the health care system. They question whether their health care providers genuinely have their best interests in mind.

“In Los Banos, on the west side of Merced [County], we have nothing…. We have transportation issues. In order to come to Merced, it’s 35 miles. If someone is in need [of medical care] they are not going to go.”

–Health Care Consortium MeetingParticipant

“There are not enough doctors and those who are available are not necessarily willing to serve the [Black] community. They may be available, but not available to the Black community. The disparities in health care access are significant. We are not talked to with respect… We do not trust the medical community.”

-African American Community Meeting Participant

“In the family health clinic it’s very discriminatory; if you are gay you are looked down upon. The doctors need better training and education. Doctors and health care providers need to be more respectful about how we are spoken to. We are people too. It’s not a crime to be queer and to be sexually active.”

–LGBTQ CommunityMeeting Participant

“Discrimination happens constantly; doctors do not value our community… [Doctors] assume that we don’t have insurance, a job, or speak English.”

-Hmong Community Meeting Participant

February 2017 | 26


Community members also stated that in order to provide better care and more effective health education, there is a need for an improved understanding of their cultures within the medical community. Participants from the Punjabi community, the Hmong community, and the Latino community mentioned a culturally appropriate approach is particularly relevant when a provider recommends diet modifications for improved nutrition and/or disease prevention. Rather than a one-size-fits-all model, community members desire health care interactions where they feel understood and health education classes that are applicable in their daily lives.

Participants in Districts 1, 3, and 5 agreed that better dissemination of information is needed regarding the health services available, including hours of operation. For example, one participant stated that people in the community are not aware of what services are available to them and when they are available.

Preventable Chronic Diseases: Health Disease, Stroke, and Diabetes

The discussion in community meetings and the voting results showed that participants are aware of diabetes and heart disease as serious health issues. However, community members expressed that they want more support in understanding disease management, particularly with diabetes. Additionally, when participants discussed how to lead healthy lifestyles with a balanced diet and exercise, they described challenges around access to healthy foods and safe places for physical activity.

“In my experience, Latino men will not come to nutritional classes, but if we have an educator go to them on their front porch it totally changes the dynamic...”

–Health Care ConsortiumMeeting Participant

“Any solution for diabetes regulation that is proposed has to be culturally appropriate. Doctors can’t make the same suggestions that they would for an American family… Doctors have to make suggestions that are appropriate for a Hmong diet, and be aware that in the Hmong community there is no word for diabetes. They call it ‘sweet blood’.”

-Hmong Community Meeting Participant

“No one knows what services are available in Merced County. Lists of resources including days and hours open, location, who is eligible, hours available, would be helpful.”

- Los Banos Community Meeting Participant

February 2017 | 27


In community meetings held in Districts 1, 2, and 5, participants discussed challenges in grasping the complexities of managing diabetes. Some participants commented that insufficient or inaccessible explanations are provided to patients about what is required to manage their diabetes. An additional barrier mentioned was the cost of testing strips. Some participants also mentioned that they used home remedies instead of seeking medical care due to affordability.

Community member discussions pointed to a clear recognition of the interconnectivity between chronic diseases, (heart disease, stroke, and diabetes) and obesity and access to healthy foods and safe places to exercise.

Meetings in Districts 1, 2, 3, and 4, and the Transition Age Youth and Hmong meetings greatly

emphasized the need for clean and safe parks with unlocked bathrooms that would encourage people to be more active and allow them to better enjoy their community. In addition to safer parks, the Hmong community meeting pointed to a need for parks with shade and without loose dogs, so that they can comfortably exercise.

Community meeting participants shared their observations that the physical education classes at schools do not provide adequate physical activity for their children. Some parents enrolled their children in other activities like boxing, but other parents stated that they could not afford auxiliary programs.

Access to healthy foods was another concern expressed in many community meetings. Similar to the challenges expressed in accessing health care, many participants observed that they lived in a food desert and would need a car in order to get to the full-service grocery stores in the City of Merced. Additionally, the cost of healthy food was highlighted as a barrier. To address this barrier, participants from the community meeting in Gustine indicated that they have a weekly Farmers Market during the warmer seasons; however, on the off seasons, they must travel to Turlock or Los Banos to obtain fresh produce. In the Transition Age

Youth meeting, one participant noted the differences in food access even between the South and North sides of the City of Merced itself, noting that there are more opportunities for making healthy food decisions for residents in North Merced, a higher income neighborhood, than for residents in South Merced, a lower income neighborhood. Culturally relevant nutrition classes were also suggested in several community meetings.

“There is a problem with not having any food stores. Most people don’t have a car and the only good stores are in [the City of] Merced.”

-Planada Community Meeting Participant

“The concept of [blood] sugars is very complicated, and many doctors and other medical professionals don't explain it well at the patient level.”

- City of Merced Community Participant

“Many men drink and smoke in the park and use the restroom [outdoors] because the park’s restrooms are locked….I don’t take my kids to the park for this reason. The picnic tables are used by the older guys doing their thing [drinking]”

- Planada Community Meeting Participant

“There is only one park in Winton, and people get shot there.”

–Winton Community Meeting Youth Participant

February 2017 | 28


Substance Abuse

Many community members spoke with emphatic concern and urgency about the perceived high visibility of substance use in their neighborhoods. For example, in all district meetings and in most population-specific meetings, residents mentioned that their families could not utilize their community parks because that is where substance users congregate. When discussing substance abuse, often the discussion intertwined with community members’ acknowledgement of the related

issues of homelessness and the perceived lack of mental health support across the county. Community members expressed concern for both adults and youth with substance abuse issues, but were particularly concerned about youth having easy access to substances, especially at their schools.

Community meeting participants stated the need for educational resources to identify drug and alcohol abuse and how to avoid addiction and peer pressure. Participants also expressed the importance of providing engaging activities for Merced County’s youth as a way to prevent drug and alcohol abuse. Participants also mentioned that there is often stigma associated with substance abuse problems, and that some people are afraid or do not know how to ask for help. Additionally, a number of participants voiced a perception that the county does not have the necessary services to treat

those with drug and alcohol abuse issues.

Participants at the District 3 and the African American community meetings also discussed the negative impacts that criminalization of substances has had in their community. Overall, most community participants agreed that drug and alcohol abuse severely affected and fragmented their community.

Income, Education, and Employment

The large domain of Income, Education, and Employment had the highest votes of all the 10 health topics. This multifaceted topic was identified at nearly every community meeting as an all-encompassing factor that impacted the community’s health. Additionally, many participants indicated that addressing disparities that exist in income, education, and employment would improve the prevention, management, and treatment of each of the health conditions which affect county residents.

“Alcohol and drug abuse is a big issue and [drugs] are cheap at schools.” -Winton Community Meeting Youth Participant

“Drug and alcohol inpatient and outpatient programs are all gone [they were defunded].”

- Atwater Community Meeting Participant

“I have seen the community [change]. It was thriving…and now because of the drugs there are so many homeless people.... There were [substance abuse] programs that are now underfunded… Youth need to have access to other activities. Otherwise it’s, ‘Let’s drink, let’s get high, there’s nothing else to do!’”

–LGBTQ Community Member Participant

February 2017 | 29


As mentioned in the section on Access to Care, many community meeting participants spoke about having limited access to health care services and shared that their income affected their ability to access services. Participants also highlighted that their income levels corresponded to their education and their ability to get the job or housing they desired, which some observed affected their mental health and contributed to substance abuse issues. Many participants stated that the opportunity to receive an education, and subsequently get a job with a steady income,

was not equitable across the different populations in Merced County. For example, one community member pointed out that those who are undocumented face challenges due to the limited availability of financial assistance for basic needs.

Section 6: Introduction to the Work Plan - Goals, Objectives, & Strategies This section presents the CHIP Work Plan which includes goals and objectives specifically designed to address each health priority area – Access to Health Care; Preventable Chronic Diseases: Heart Disease, Stroke, and Diabetes; Substance Abuse; and Health Equity and Social Determinants of Health. Each objective delineates strategies that fall into the following broad categories which cover a continuum of activities from planning to implementation to evaluation:

Each objective also contains a list of potential indicators that may be used to assess progress toward implementing the CHIP strategies. These indicators will be further defined in the annual implementation plan. A list of responsible agencies/partners, not linked to specific strategies, but rather, more broadly, to each objective, is also included.

CHIP Action Categories Partnerships Evaluation

Communication Assessment

Policy Development/Implementation Youth/Adult Engagement

Resource Development Stakeholder/Consumer Education

Practice Enhancement Other

“How do we change the cycle? When you are poor you can’t afford a house, then you’re looked down upon because you are poor; this can then lead to mental health issues, so I drink or smoke to take the edge off.”

-African American Community Meeting Participant

“For undocumented adults, assistance is not available; people have to choose whether to pay for housing or buy food. You can do more things with a higher income.”

-Youth Community Meeting Participant

February 2017 | 30


Merced County Community Health Improvement

Work Plan

2017 - 2022

February 2017 | 31

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: A

cces

s to

Hea

lth C

are

PRIO

RITY

ARE

A 1:

ACC

ESS

TO H

EALT

H C

ARE

Goal

: All

indi

vidu

als

in M

erce

d Co

unty

hav

e ac

cess

to q

ualit

y he

alth

car

e.

Obj

ectiv

e 1.

1: B

y 20

22, i

ncre

ase

the

num

ber o

f hea

lth c

are

prov

ider

s, in

all

field

s, in

Mer

ced

Coun

ty.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Part

ners

hips

Iden

tify

and

shar

e ex

ampl

es o

f hea

lth c

are

orga

niza

tion

part

ners

hips

succ

essf

ully

leve

ragi

ng c

linic

al p

erso

nnel

, and

im

plem

ent w

here

feas

ible

.

Reso

urce

Dev

elop

men

t

Incr

ease

locu

m te

nens

.2

In

crea

se te

lehe

alth

opp

ortu

nitie

s.

Esta

blish

med

ical

resid

ency

pro

gram

s in

part

ners

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with

ed

ucat

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l ins

titut

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and

med

ical

org

aniza

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.

Prac

tice

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recr

uitm

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ncen

tives

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rovi

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.

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atio

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te h

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ipel

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ram

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rimar

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ost-

seco

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mun

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nhan

cem

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irabi

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g m

ore

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catio

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mpl

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and

recr

eatio

nal

oppo

rtun

ities

for h

ealth

pro

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iona

ls an

d th

eir f

amili

es.

• N

umbe

r of p

rovi

ders

in M

erce

d Co

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•

Rese

arch

repo

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car

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gani

zatio

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artn

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ips

• N

umbe

r of g

roup

s with

whi

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part

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hip

repo

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shar

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rtne

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p m

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enda

s and

m

inut

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• N

umbe

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cum

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• N

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xpan

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•

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ntiv

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•

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e.g.

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ntra

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• Sc

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City

/Cou

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•

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/Cou

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ublic

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whe

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th c

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face

s te

mpo

rary

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es d

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es, i

llnes

s, o

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ause

s. L

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nens

phy

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an h

elp

fill t

hose

vac

anci

es to

mai

ntai

n pa

tient

car

e qu

ality

.

Febr

uary

201

7 |

32

Mer

ced

Cou

nty

Com

mun

ity H

ealth

Impr

ovem

ent P

lan:

Acc

ess

to H

ealth

Car

e

Obj

ectiv

e 1.

2: B

y 20

22, e

nsur

e co

mpr

ehen

sive

, cul

tura

lly re

spon

sive

, and

qua

lity

heal

th c

are

for a

ll.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

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agen

cies

/ pa

rtne

rs

Prac

tice

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ent

En

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app

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leve

l of c

are

as a

par

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ualit

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re.

U

se c

are

base

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cent

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to im

prov

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d m

aint

ain

qual

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d co

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num

ber a

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artic

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ion

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s in

patie

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pret

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com

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(CHW

)/pr

omot

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inpa

tient

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n

In

crea

se p

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duca

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abou

t cul

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•N

umbe

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vel t

riage

prog

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staf

f•

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inap

prop

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visit

s•

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and

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port

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and

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and

non

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•N

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ay (2

11)

Febr

uary

201

7 |

33

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: A

cces

s to

Hea

lth C

are

Obj

ectiv

e 1.

4: B

y 20

22, c

reat

e co

mm

unity

-bas

ed h

ealth

supp

ort s

ervi

ces i

nten

ded

to e

nhan

ce c

linic

al c

are.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

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ble

agen

cies

/ pa

rtne

rs

Stak

ehol

der/

Cons

umer

Edu

catio

n

Cond

uct o

utre

ach

to a

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duca

tion

of c

onsu

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s to

incr

ease

app

ropr

iate

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lth in

sura

nce

utili

zatio

n.

Educ

ate

cons

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s abo

ut th

e im

port

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of p

reve

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ive

care

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Reso

urce

Dev

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Build

Com

mun

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prov

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ish F

amily

Res

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incr

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Prac

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Enha

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Prom

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vers

al, s

tand

ardi

zed

0-5

year

dev

elop

men

tal s

cree

ning

s.

• N

umbe

r of n

ew c

onsu

mer

edu

catio

n op

port

uniti

es

• N

umbe

r of n

ew c

onsu

mer

pre

vent

ativ

e ca

re o

ppor

tuni

ties

• N

umbe

r of C

HWs

• Es

tabl

ish o

ne F

amily

Res

ourc

e Ce

nter

•

Num

ber o

f new

reso

urce

s for

scho

ol

liaiso

ns

• O

ne n

ew m

edic

al tr

ansp

orta

tion

reso

urce

•

Num

ber o

f pro

vide

rs u

tilizi

ng

stan

dard

ized

deve

lopm

enta

l scr

eeni

ngs

• He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, ho

spita

ls, c

linic

s, b

ehav

iora

l hea

lth

prov

ider

s)

• Ce

ntra

l Cal

iforn

ia A

llian

ce fo

r Hea

lth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• He

alth

Hom

e O

rgan

izatio

ns

• Co

ntin

uum

of C

are

• Sc

hool

Dist

ricts

•

Mer

ced

Coun

ty O

ffice

of E

duca

tion

• Fi

rst 5

Mer

ced

Coun

ty

Obj

ectiv

e 1.

5: B

y 20

22, s

uppo

rt in

tegr

atio

n of

prim

ary

care

and

beh

avio

ral h

ealth

with

in th

e he

alth

car

e sy

stem

.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Prac

tice

Enha

ncem

ent/

Asse

ssm

ent

Anal

yze

the

path

way

s for

refe

rral

s acr

oss p

rovi

der s

yste

ms

and

stra

tegi

ze m

etho

ds to

incr

ease

con

tinui

ty o

f pat

ient

ca

re.

Incr

ease

prim

ary

care

pro

vide

rs’ u

tiliza

tion

of b

ehav

iora

l he

alth

and

subs

tanc

e ab

use

scre

enin

g to

ols.

Educ

atio

n

Incr

ease

aw

aren

ess a

mon

g co

nsum

ers o

f rol

e of

prim

ary

care

pro

vide

rs a

s a re

sour

ce in

mild

to m

oder

ate

beha

vior

al

heal

th c

once

rns a

nd su

bsta

nce

abus

e.

• O

ne n

ew li

nkag

e pa

thw

ay c

reat

ed

• N

umbe

r of n

ew p

rovi

ders

usin

g be

havi

oral

hea

lth a

nd su

bsta

nce

abus

e sc

reen

ing

tool

s •

Num

ber c

onsu

mer

s see

king

beh

avio

ral

heal

th se

rvic

es a

t prim

ary

care

site

s

• He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, ho

spita

ls, c

linic

s, b

ehav

iora

l hea

lth

prov

ider

s)

• Ce

ntra

l Cal

iforn

ia A

llian

ce fo

r Hea

lth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• M

erce

d Co

unty

Dep

artm

ent o

f Beh

avio

ral

Heal

th a

nd R

ecov

ery

Serv

ices

Febr

uary

201

7 |

34

Mer

ced

Cou

nty

Com

mun

ity H

ealth

Impr

ovem

ent P

lan:

Pre

vent

able

Chr

onic

Dise

ases

: Hea

rt D

iseas

e, S

troke

, and

Dia

bete

s PR

IORI

TY A

REA

2: P

REVE

NTA

BLE

CHRO

NIC

DIS

EASE

S: H

EART

DIS

EASE

, STR

OK

E, A

ND

DIA

BETE

S

Goal

: Mer

ced

Coun

ty w

ill o

ptim

ize

the

soci

al a

nd p

hysi

cal e

nvir

onm

ents

to s

uppo

rt h

ealt

hy li

fest

yles

and

red

uce

the

risk

of c

hron

ic d

isea

se fo

r al

l res

iden

ts.

Obj

ectiv

e 2.

1: B

y 20

22, a

ddre

ss p

olic

y, sy

stem

, and

env

ironm

enta

l fac

tors

inte

nded

to p

rom

ote

and

impr

ove

com

mun

ity h

ealth

.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t/Pa

rtne

rshi

ps

In

crea

se n

umbe

r of s

hare

d us

e ag

reem

ents

.

Impr

ove

qual

ity a

nd sa

fety

of p

arks

.

Incr

ease

fund

ing

for p

arks

.

Incr

ease

opp

ortu

nitie

s to

obta

in h

ealth

y fo

ods

thro

ugh

farm

ers m

arke

t, co

mm

unity

gar

dens

, and

groc

ery

stor

es.

In

crea

se to

bacc

o-fr

ee p

lace

s and

rest

rict a

cces

s to

toba

cco

prod

ucts

(inc

ludi

ng e

-cig

aret

tes)

.

•N

umbe

r of n

ew sh

ared

use

agr

eem

ents

.•

New

fund

ing

for p

arks

•In

cide

nce

of c

rime

at p

arks

•N

umbe

r of n

ew fa

rmer

s mar

kets

,co

mm

unity

mar

kets

, and

hea

lthy

food

outle

ts•

Num

ber o

f tob

acco

reta

ilers

(mai

ntai

n or

decr

ease

cur

rent

num

bers

)•

Num

ber o

f new

smok

e-fr

ee p

olic

ies

•Sc

hool

Dist

ricts

•Co

mm

unity

-Bas

ed O

rgan

izatio

ns•

City

/Cou

nty

Park

s and

Rec

reat

ion

Depa

rtm

ents

•La

w e

nfor

cem

ent

•M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic H

ealth

•Ci

ty C

ounc

ils/ B

oard

of S

uper

viso

rs•

Busin

ess C

omm

unity

•Ci

ty/C

ount

y Pl

anni

ng D

epar

tmen

ts•

Farm

ers/

Grow

ers/

Prod

ucer

s•

Faith

-Bas

ed O

rgan

izatio

ns

Obj

ectiv

e 2.

2: B

y 20

22, i

ncre

ase

com

mun

ity a

cces

s to

soci

al n

etw

orks

and

supp

ort s

yste

ms t

o re

duce

and

man

age

prev

enta

ble

chro

nic

dise

ases

.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t

De

velo

p CH

W/p

rom

otor

a ne

twor

k to

exp

and

peer

-le

d or

pee

r-to

-pee

r pro

gram

s (e.

g. C

hron

ic D

iseas

eSe

lf-M

anag

emen

t Pro

gram

, Pee

rs fo

r Pro

gres

s, m

icro

clin

ics)

and

con

nect

com

mun

ity m

embe

rs to

serv

ices

.

Prac

tice

Enha

ncem

ent

Id

entif

y op

port

uniti

es fo

r rei

mbu

rsem

ent o

fCH

Ws/

prom

otor

as (e

.g. C

CAH

and

stat

e le

vel).

•N

umbe

r of C

HWs

•N

umbe

r new

of p

eer-

led

clas

ses o

ffere

d•

Num

ber o

f 211

refe

rral

s to

clas

ses

•De

velo

ped

stra

tegy

for r

eim

burs

emen

t•

Perc

ent o

f CHW

wor

k th

at is

reim

burs

ed

•He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, hos

pita

ls,cl

inic

s, b

ehav

iora

l hea

lth p

rovi

ders

)•

Cent

ral C

alifo

rnia

Alli

ance

for H

ealth

(CCA

H)•

Mer

ced

Coun

ty D

epar

tmen

t of P

ublic

Hea

lth•

Com

mun

ity-B

ased

Org

aniza

tions

•U

nite

d W

ay (2

11)

•Fa

ith-B

ased

Org

aniza

tions

Febr

uary

201

7 |

35

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: P

reve

ntab

le C

hron

ic D

iseas

es: H

eart

Dise

ase,

Stro

ke, a

nd D

iabe

tes

Obj

ectiv

e 2.

3: B

y 20

22, i

ncre

ase

cultu

rally

app

ropr

iate

hea

lth e

duca

tion

oppo

rtun

ities

for M

erce

d Co

unty

’s d

iver

se p

opul

atio

ns.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Stak

ehol

der/

Cons

umer

Edu

catio

n

Util

ize h

ealth

edu

catio

n m

ater

ials

and

met

hods

in

com

mun

ity, s

choo

l, an

d cl

inic

al se

ttin

gs th

at a

re re

leva

nt to

di

vers

e po

pula

tions

in M

erce

d Co

unty

.

En

gage

CHW

s/pr

omot

oras

to e

xpan

d cu

ltura

lly a

ppro

pria

te

peer

-led

or p

eer-

to-p

eer h

ealth

edu

catio

n pr

ogra

ms.

• N

umbe

r of n

ew c

ultu

rally

rele

vant

ed

ucat

ion

mat

eria

ls/m

etho

ds u

tilize

d in

co

mm

unity

•

Num

ber o

f new

ent

ities

usin

g cu

ltura

lly

rele

vant

edu

catio

n m

ater

ials/

met

hods

in

com

mun

ity

• N

umbe

r of n

ew p

eer-

to-p

eer p

rogr

ams

utili

zing

CHW

s

• He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, ho

spita

ls, c

linic

s, b

ehav

iora

l hea

lth

prov

ider

s)

• Ce

ntra

l Cal

iforn

ia A

llian

ce fo

r Hea

lth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• Sc

hool

Dist

ricts

Obj

ectiv

e 2.

4: B

y 20

22, i

ncre

ase

prov

ider

par

ticip

atio

n in

pre

vent

ativ

e m

arke

r ide

ntifi

catio

n an

d re

ferr

al to

cul

tura

lly a

ppro

pria

te

com

mun

ity su

ppor

t sys

tem

s.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Polic

y De

velo

pmen

t/Im

plem

enta

tion

Crea

te p

olic

ies a

nd sy

stem

s to

enco

urag

e ea

rly id

entif

icat

ion

of p

oten

tial c

hron

ic d

iseas

es a

nd re

ferr

al (e

.g. i

dent

ifica

tion

of p

re-d

iabe

tes)

.

Stak

ehol

der/

Cons

umer

Edu

catio

n

Prom

ote

Gree

n Rx

(pre

scrip

tion

for e

xerc

ise, u

se o

f gre

en

spac

e, e

tc.).

Reso

urce

Dev

elop

men

t

Incr

ease

bi-d

irect

iona

l ref

erra

ls be

twee

n co

mm

unity

and

cl

inic

al h

ealth

and

soci

al su

ppor

t ser

vice

s.

• N

umbe

r of n

ew p

olic

ies/

syst

ems f

or e

arly

id

entif

icat

ion

of p

oten

tial c

hron

ic d

iseas

es

• N

umbe

r of r

efer

rals

of a

t-risk

pat

ient

s to

heal

thy

lifes

tyle

cla

sses

•

Num

ber o

r pro

vide

rs u

sing

U.S

. Pr

even

tion

Serv

ices

Tas

k Fo

rce

guid

elin

es

for s

cree

ning

•

Num

ber o

f pro

vide

rs u

sing

Gre

en R

x.

• N

umbe

r of b

i-dire

ctio

nal r

efer

rals

betw

een

com

mun

ity a

nd c

linic

al

heal

th/s

uppo

rt se

rvic

es

• He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, ho

spita

ls, c

linic

s, b

ehav

iora

l hea

lth

prov

ider

s)

• Ce

ntra

l Cal

iforn

ia A

llian

ce fo

r Hea

lth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• U

nite

d W

ay (2

11)

• Ph

arm

acie

s

Febr

uary

201

7 |

36

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: S

ubst

ance

Abu

se PR

IORI

TY A

REA

3: S

UBS

TAN

CE A

BUSE

Goal

: Inc

reas

e w

elln

ess

in M

erce

d Co

unty

by

addr

essi

ng th

e co

ndit

ions

that

lead

to d

rug

and

alco

hol a

buse

.

Obj

ectiv

e 3.

1: B

y 20

22, i

ncre

ase

trea

tmen

t cap

acity

and

acc

essi

bilit

y to

subs

tanc

e ab

use

reso

urce

s.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t

Incr

ease

trea

tmen

t opp

ortu

nitie

s in

alte

rnat

ive

com

mun

ity

sett

ings

(e.g

., sc

hool

s, c

hurc

hes,

etc

.)

Prac

tice

Enha

ncem

ent

Asse

ss d

epre

ssio

n in

you

th in

alte

rnat

ive

com

mun

ity se

ttin

gs.

• N

umbe

r of c

lass

es in

alte

rnat

ive

loca

tions

•

Num

ber o

f clie

nts s

erve

d in

alte

rnat

ive

loca

tions

•

Num

ber o

f you

th sc

reen

ed fo

r dep

ress

ion

in a

ltern

ativ

e lo

catio

ns

• De

part

men

t of B

ehav

iora

l Hea

lth a

nd

Reco

very

Ser

vice

s •

Scho

ol D

istric

ts

• Fa

ith-B

ased

Org

aniza

tions

•

Com

mun

ity-B

ased

Org

aniza

tions

•

Boys

and

Girl

s Clu

b an

d ot

her

com

mun

ity p

lace

s

Febr

uary

201

7 |

37

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: S

ubst

ance

Abu

se

Obj

ectiv

e 3.

2: B

y 20

22, d

evel

op p

ract

ices

and

pol

icie

s to

enco

urag

e pr

even

tion

rath

er th

an p

unis

hmen

t of s

ubst

ance

abu

se, a

nd p

rom

ote

trea

tmen

t and

re

cove

ry.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t

Esta

blish

nee

dle

exch

ange

and

reco

very

and

supp

ort s

ervi

ces.

Pr

omot

e Em

ploy

ee A

ssist

ance

Pro

gram

s (EA

P) a

mon

g em

ploy

ers a

s an

alte

rnat

ive

to d

iscip

linar

y ac

tion

or

term

inat

ion.

De

velo

p CH

W p

eer-

to-p

eer a

ppro

ach

to c

onne

ct re

cent

ly

inca

rcer

ated

“re

-ent

ry”

indi

vidu

als t

o su

ppor

t res

ourc

es th

at

incr

ease

succ

essf

ul re

-ent

ry a

nd re

duce

reci

divi

sm.

Polic

y De

velo

pmen

t/Im

plem

enta

tion

Advo

cate

for R

esto

rativ

e Ju

stic

e Pr

ogra

ms i

n M

erce

d Co

unty

sc

hool

s.

• Es

tabl

ishm

ent o

f nee

dle

exch

ange

pr

ogra

m

• N

umbe

r of c

lient

s ent

erin

g tr

eatm

ent

prog

ram

s fro

m n

eedl

e ex

chan

ge p

rogr

am

• N

umbe

r of p

rese

ntat

ions

on

bene

fit o

f EA

P to

em

ploy

ers/

empl

oyee

s •

Num

ber o

f em

ploy

ees w

ho u

se E

AP

• N

umbe

r of e

mpl

oyer

s rep

ortin

g us

e of

EA

P as

an

alte

rnat

ive

actio

n •

Num

ber o

f CHW

s •

Num

ber o

f ree

ntry

indi

vidu

als p

aire

d w

ith

a CH

W

• N

umbe

r of n

ew sc

hool

s with

Res

tora

tive

Just

ice

prog

ram

s •

Num

ber o

f stu

dent

who

go

thro

ugh

Rest

orat

ive

Just

ice

Prog

ram

• Di

gnity

Hea

lth M

ercy

Med

ical

Cen

ter

Mer

ced

Fam

ily C

are

Cl

inic

•

UC

Davi

s Med

ical

Res

iden

cy P

rogr

am

• Ci

ty o

f Mer

ced

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• M

erce

d Co

unty

Hum

an S

ervi

ces

Agen

cy

• M

erce

d Co

unty

Dep

artm

ent o

f Be

havi

oral

Hea

lth a

nd R

ecov

ery

Serv

ices

•

Scho

ol D

istric

ts

• M

erce

d Co

unty

Offi

ce o

f Edu

catio

n •

Maj

or e

mpl

oyer

s •

Law

enf

orce

men

t •

Mer

ced

Coun

ty P

roba

tion

Depa

rtm

ent

• Sh

eriff

’s D

epar

tmen

t (Ja

ils)

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• U

nite

d W

ay (2

11)

Febr

uary

201

7 |

38

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: S

ubst

ance

Abu

se

Obj

ectiv

e 3.

3: B

y 20

22, i

nves

t in

yout

h to

dec

reas

e an

d pr

even

t sub

stan

ce a

buse

and

pro

vide

alte

rnat

ives

to su

bsta

nce

use.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t

Incr

ease

wel

lnes

s res

ourc

es in

hig

h sc

hool

s, fa

ith-b

ased

or

gani

zatio

ns, c

omm

unity

sett

ings

, etc

.

De

velo

p an

d su

ppor

t saf

e an

d pr

oduc

tive

com

mun

ity-b

ased

ac

tiviti

es fo

r you

th (e

.g.,

park

s, c

ultu

ral c

omm

unity

cen

ter,

etc.

) and

redu

ce b

arrie

rs to

acc

ess e

xist

ing

reso

urce

s and

sp

aces

(e.g

. sch

ools

afte

r hou

rs, B

oys a

nd G

irls c

lubs

, etc

.)

Cr

eate

trai

ning

and

job

oppo

rtun

ities

for y

outh

(e.g

. par

ks a

nd

recr

eatio

n).

• N

umbe

r of n

ew si

te lo

catio

ns w

ith

wel

lnes

s res

ourc

es

• N

umbe

r of n

ew c

omm

unity

-bas

ed

activ

ities

for y

outh

•

Num

ber o

f new

trai

ning

and

job

oppo

rtun

ities

for y

outh

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• M

erce

d Co

unty

Hum

an S

ervi

ces

Agen

cy

• M

erce

d Co

unty

Dep

artm

ent o

f Be

havi

oral

Hea

lth a

nd R

ecov

ery

Serv

ices

•

Mer

ced

Coun

ty O

ffice

of E

duca

tion

• Sc

hool

Dist

ricts

•

Faith

-Bas

ed O

rgan

izatio

ns

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• Co

unty

/City

Pla

nnin

g De

part

men

ts

• Co

unty

/City

Par

ks a

nd R

ecre

atio

n •

Wor

kfor

ce In

vest

men

t Boa

rd

• Bu

sines

ses

• Ch

ambe

r of C

omm

erce

•

City

Cou

ncil/

Boa

rd o

f Sup

ervi

sors

•

Mer

ced

Com

mun

ity C

olle

ge

Febr

uary

201

7 |

39

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: S

ubst

ance

Abu

se

Obj

ectiv

e 3.

4: B

y 20

22, e

duca

te a

nd e

ngag

e co

mm

unity

mem

bers

and

stak

ehol

ders

aro

und

fact

ors t

hat c

ontr

ibut

e to

the

initi

atio

n an

d pe

rpet

uatio

n of

su

bsta

nce

abus

e (e

.g. A

CEs)

.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Asse

ssm

ent

Asse

ss w

hich

Adv

erse

Chi

ldho

od E

xper

ienc

es

(ACE

s) a

re m

ost p

reva

lent

in M

erce

d Co

unty

th

roug

h da

ta c

olle

ctio

n (e

.g.,

Head

Sta

rt fa

mili

es).

Prac

tice

Enha

ncem

ent

Educ

ate

prov

ider

s on

impo

rtan

ce a

nd in

crea

se

utili

zatio

n of

ACE

scre

enin

g to

ols.

Ed

ucat

e pr

ovid

ers o

n in

fluen

ce o

f and

incr

ease

sc

reen

ing

for r

isk fa

ctor

s tha

t cou

ld le

ad to

su

bsta

nce

abus

e (e

.g. j

ob lo

ss, r

ecen

t los

s,

syst

emic

raci

sm, p

over

ty).

• N

umbe

r of A

CE e

valu

atio

ns c

ompl

eted

•

Perc

ent o

f chi

ldre

n w

ith h

igh

ACEs

•

Num

ber o

f ACE

edu

catio

nal o

ppor

tuni

ties

for p

rovi

ders

•

Num

ber o

f pro

vide

rs re

gula

rly a

sses

sing

ACEs

•

Num

ber o

f pro

vide

rs u

tilizi

ng su

bsta

nce

abus

e ris

k fa

ctor

scre

enin

gs

• M

erce

d Co

unty

Dep

artm

ent o

f Beh

avio

ral H

ealth

an

d Re

cove

ry S

ervi

ces

• M

erce

d Co

unty

Offi

ce o

f Edu

catio

n •

Mer

ced

Coun

ty H

ead

Star

t •

Heal

th c

are

prov

ider

par

tner

s (e.

g., h

ospi

tals,

cl

inic

s, b

ehav

iora

l hea

lth p

rovi

ders

) •

Cent

ral C

alifo

rnia

Alli

ance

for H

ealth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic H

ealth

•

Com

mun

ity-B

ased

Org

aniza

tions

Obj

ectiv

e 3.

5: B

y 20

22, s

uppo

rt H

ousi

ng F

irst a

nd o

ther

sobe

r liv

ing

effo

rts,

co-

loca

ted

with

subs

tanc

e ab

use

prev

entio

n an

d tr

eatm

ent p

rogr

ams,

to c

reat

e st

able

env

ironm

ents

for t

he h

omel

ess.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Polic

y De

velo

pmen

t/Im

plem

enta

tion

Enco

urag

e be

st p

ract

ice

hous

ing

mod

els.

Su

ppor

t qua

lity

cont

rol m

easu

res f

or so

ber l

ivin

g en

viro

nmen

ts.

• As

sess

men

t of s

elec

ted

hous

ing

mod

els

agai

nst b

est p

ract

ices

•

Num

ber o

f sob

er li

ving

env

ironm

ents

with

qu

ality

con

trol

mea

sure

s in

plac

e

• Av

erag

e qu

ality

con

trol

scor

e of

sobe

r liv

ing

envi

ronm

ents

•

Num

ber o

f org

aniza

tions

impl

emen

ting

Heal

th H

ome

mod

el

• M

erce

d Co

unty

Dep

artm

ent o

f Beh

avio

ral H

ealth

an

d Re

cove

ry S

ervi

ces

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic H

ealth

•

Com

mun

ity-B

ased

Org

aniza

tions

•

Cont

inuu

m o

f Car

e •

Cent

ral C

alifo

rnia

Alli

ance

for H

ealth

(CCA

H)

• M

erce

d Co

unty

Hou

sing

Auth

ority

•

City

Cou

ncil/

Boa

rd o

f Sup

ervi

sors

Febr

uary

201

7 |

40

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: H

ealth

Equ

ity a

nd S

ocia

l Det

erm

inan

ts o

f Hea

lth

PRIO

RITY

ARE

A 4:

HEA

LTH

EQ

UIT

Y AN

D S

OCI

AL D

ETER

MIN

ANTS

OF

HEA

LTH

Goal

: All

resi

dent

s in

Mer

ced

Coun

ty w

ill h

ave

equa

l opp

ortu

niti

es to

lead

hea

lthy

live

s, r

egar

dles

s of

rac

e,

ethn

icit

y, s

exua

l ori

enta

tion

, gen

der

iden

tity

, inc

ome

leve

l, ed

ucat

ion,

or

empl

oym

ent s

tatu

s.

Obj

ectiv

e 4.

1: B

y 20

22, b

uild

and

mai

ntai

n pa

rtne

rshi

ps w

ith a

bro

ad b

ase

of c

omm

unity

sect

ors (

e.g.

, fai

th-b

ased

, sch

ools

, res

iden

ts, e

tc.).

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Part

ners

hips

Crea

te (a

s nee

ded)

and

/or l

ever

age

(exi

stin

g) c

omm

unity

ac

tion

coal

ition

(s) t

o m

ove

com

mun

ity-w

ide

heal

th e

quity

ef

fort

s for

war

d.

Incr

ease

cou

nty-

wid

e co

ordi

natio

n of

equ

ity e

ffort

s to

decr

ease

dup

licat

ion

and

max

imize

lim

ited

reso

urce

s.

Yout

h/Ad

ult E

ngag

emen

t

Trai

n re

siden

ts o

n co

mm

unity

eng

agem

ent.

• Co

aliti

on a

gend

as a

nd m

eetin

g m

inut

es

• N

umbe

r of a

genc

ies w

ith a

ctiv

e pa

rtic

ipat

ion

in e

quity

coa

litio

ns

• N

umbe

r of t

rain

ings

on

com

mun

ity

enga

gem

ent f

or re

siden

ts

All

Obj

ectiv

e 4.

2: B

y 20

22, d

ecre

ase

pove

rty

and

incr

ease

lite

racy

and

edu

catio

n, a

nd e

mpl

oym

ent o

ppor

tuni

ties.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Reso

urce

Dev

elop

men

t

Prom

ote

early

chi

ldho

od d

evel

opm

ent a

nd sc

hool

re

adin

ess p

rogr

ams.

Supp

ort s

trat

egie

s for

alte

rnat

ive

educ

atio

n an

d em

ploy

men

t opp

ortu

nitie

s (e.

g., G

ED p

repa

ratio

n su

ppor

ts,

skill

-bui

ldin

g op

port

uniti

es, v

ocat

iona

l or t

rade

scho

ols,

ESL

fo

r adu

lts).

Supp

ort o

ppor

tuni

ties f

or li

ving

wag

e jo

bs.

Incr

ease

affo

rdab

le li

cens

ed c

hild

car

e slo

ts.

Prom

ote

esta

blish

men

t of m

inor

ity-o

wne

d ne

w b

usin

esse

s an

d bu

sines

ses w

ith d

iver

sifie

d em

ploy

ee b

ase.

• N

umbe

r of e

arly

chi

ldho

od d

evel

opm

ent

and

scho

ol re

adin

ess p

rogr

am sl

ots

• N

umbe

r of n

ew st

rate

gies

impl

emen

ted

• N

umbe

r of l

ivin

g w

age

job

initi

ativ

es

• N

umbe

r of a

fford

able

lice

nsed

chi

ld c

are

slots

•

Num

ber o

f new

min

ority

-ow

ned

busin

esse

s •

Impl

emen

tatio

n of

trai

ning

pro

gram

s to

incr

ease

num

ber o

f wor

kers

qua

lifie

d fo

r sk

illed

labo

r job

s (i.e

., te

chno

logy

, fin

ance

)

• M

erce

d Co

unty

Offi

ce o

f Edu

catio

n •

Mer

ced

Coun

ty H

ead

Star

t •

Firs

t 5 M

erce

d Co

unty

•

Mer

ced

Coun

ty D

epar

tmen

t of P

ublic

He

alth

•

Wor

kfor

ce In

vest

men

t Boa

rd

• M

erce

d Co

unty

Hum

an S

ervi

ces A

genc

y •

Busin

ess C

omm

unity

•

Mer

ced

Com

mun

ity C

olle

ge

• Ch

ambe

r of C

omm

erce

•

Com

mun

ity-B

ased

Org

aniza

tions

Febr

uary

201

7 |

41

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: H

ealth

Equ

ity a

nd S

ocia

l Det

erm

inan

ts o

f Hea

lth

Obj

ectiv

e 4.

3: B

y 20

22, i

mpr

ove

the

built

env

ironm

ent t

o pr

ovid

e he

alth

-pro

mot

ing

com

mun

ity p

lace

s for

all.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Asse

ssm

ent

Asse

ss d

ensit

y of

acc

ess p

oint

s to

decr

ease

ava

ilabi

lity

of

unhe

alth

y su

bsta

nces

(e.g

., al

coho

l and

toba

cco)

and

incr

ease

av

aila

bilit

y of

hea

lthy

optio

ns (e

.g.,

frui

ts a

nd v

eget

able

s) in

low

po

vert

y ar

eas.

Oth

er

Colla

bora

te w

ith p

lann

ing

depa

rtm

ents

to p

rom

ote

com

mun

ity

desig

n th

at e

ncou

rage

s hea

lth (e

.g.,

mix

ed u

se, c

ompa

ct u

se,

sidew

alks

, mor

e gr

ocer

y st

ores

, zon

ing,

etc

.)

In

crea

se p

ublic

tran

spor

tatio

n op

tions

to e

duca

tion

and

empl

oym

ent c

ente

rs.

• De

nsity

ratio

of h

ealth

y/un

heal

thy

optio

ns in

hig

h/lo

w p

over

ty a

reas

•

One

new

com

mun

ity d

esig

n/po

licy

chan

ge to

pro

mot

e he

alth

•

One

new

tran

spor

tatio

n de

sign/

polic

y ch

ange

to p

rom

ote

heal

th

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• M

erce

d Co

unty

Dep

artm

ent o

f Be

havi

oral

Hea

lth a

nd R

ecov

ery

Serv

ices

•

City

/Cou

nty

Plan

ning

Dep

artm

ents

•

City

Cou

ncil/

Boa

rd o

f Sup

ervi

sors

•

Busin

ess C

omm

unity

•

Cham

ber o

f Com

mer

ce

• Co

mm

unity

-Bas

ed O

rgan

izatio

ns

• Yo

uth

Gro

ups

• M

erce

d Co

unty

Ass

ocia

tion

of

Gov

ernm

ents

•

City

/Cou

nty

Publ

ic W

orks

Dep

artm

ents

Febr

uary

201

7 |

42

Mer

ced

Cou

nty

Co

mm

unity

Hea

lth Im

prov

emen

t Pla

n: H

ealth

Equ

ity a

nd S

ocia

l Det

erm

inan

ts o

f Hea

lth

Obj

ectiv

e 4.

4: B

y 20

22, i

dent

ify a

nd a

ddre

ss h

ealth

dis

parit

ies a

nd p

rom

ote

heal

th e

quity

for a

ll in

Mer

ced

Coun

ty.

Stra

tegi

es

Pote

ntia

l Ind

icat

ors

Resp

onsi

ble

agen

cies

/ pa

rtne

rs

Polic

y De

velo

pmen

t/Im

plem

enta

tion

Crea

te p

olic

y an

d ch

ange

pro

cedu

re a

roun

d da

ta c

olle

ctio

n m

etho

ds fo

r rac

e/et

hnic

ity to

dis-

aggr

egat

e da

ta (e

.g.,

Asia

n-Hm

ong)

and

col

lect

for s

mal

ler (

e.g.

, Afr

ican

Am

eric

an)

popu

latio

ns.

Prac

tice

Enha

ncem

ent

Deve

lop

chec

klist

for p

rovi

ders

to a

ssur

e pr

ovisi

on o

f cul

tura

lly

appr

opria

te c

are

and

serv

ices

.

Asse

ssm

ent

Map

soci

al d

eter

min

ants

of h

ealth

and

, as p

ossib

le, h

ealth

in

dica

tors

(e.g

., th

ose

avai

labl

e vi

a He

alth

Info

rmat

ion

Exch

ange

), to

iden

tify

and

focu

s effo

rts o

n ar

eas i

n m

ost n

eed.

Co

mpl

ete

gap

anal

ysis

for a

vaila

ble

soci

al su

ppor

t res

ourc

es fo

r re

siden

ts u

p to

250

% o

f the

Fed

eral

Pov

erty

Lev

el (F

PL) a

nd

stra

tegi

ze so

lutio

ns fo

r ide

ntifi

ed g

aps.

• N

umbe

r of e

ntiti

es c

olle

ctin

g de

mog

raph

ic d

ata

utili

zing

popu

latio

n su

bset

s •

Num

ber o

f dat

a an

alys

es u

tilizi

ng d

is-ag

greg

ated

dat

a •

Num

ber o

f pro

vide

rs u

sing

chec

klist

•

Num

ber o

f pla

nnin

g ef

fort

s usin

g m

appi

ng to

iden

tify

and

focu

s st

rate

gies

•

Gap

ana

lysis

com

plet

ed

• He

alth

car

e pr

ovid

er p

artn

ers (

e.g.

, ho

spita

ls, c

linic

s, b

ehav

iora

l hea

lth

prov

ider

s)

• Ce

ntra

l Cal

iforn

ia A

llian

ce fo

r Hea

lth

(CCA

H)

• M

erce

d Co

unty

Dep

artm

ent o

f Pub

lic

Heal

th

• M

erce

d Co

unty

Dep

artm

ent o

f Be

havi

oral

Hea

lth a

nd R

ecov

ery

Serv

ices

•

Mer

ced

Coun

ty H

uman

Ser

vice

s Ag

ency

•

Mer

ced

Coun

ty O

ffice

of E

duca

tion

• Co

mm

unity

-Bas

ed O

rgan

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Appendices

2017 – 2022

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Appendix A: Community Engagement Handouts

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Appendix B: List of Community Outreach Venues Websites and Social Media

News and Online Calendars ABC 30 News, City Websites, Merced County Events, Merced Sun Star Community Calendar, Eventful, Townplanner

Facebook Merced SunStar, Building Healthy Communities, We'Ced Youth Media, Leadership Merced, Invest in Merced's Youth, The kNOW youth Media, Merced LGBTQ Center, Boys and Girls Club of Merced, The Original Merced Certified Farmers Market, MercedNow, Merced DNA (Downtown Neighborhood Association)

Outreach Emails Alliance for Community Research and Development

Livingston Medical

Beacon Health Options Merced City School District

Building Healthy Communities, Merced Merced College

California Endowment Merced County Community Action Agency

California Highway Patrol Merced County Office of Education

California Rural Legal Assistance Merced County Health Care Consortium

California State Assembly Merced County Mental Health Board

California State University, Stanislaus Merced County Whole Health Partnership

Castle Family Health Centers, Inc. Merced Insurance Agency

Central California Alliance for Health Merced Medical Supply

City Clerks (from multiple City jurisdictions) Merced-Mariposa County Medical Society

City Managers (from multiple City jurisdictions) MFA Medical Group

City of Atwater Planned Parenthood, Mar Monte

Covered California Insurance Parent Institute for Quality Education (PIQE)

Dignity Health Mercy Medical Center Merced Senate of California

Family and Social Services Sutter Health Memorial Hospital Los Banos

Golden Valley Health Centers University of California, Merced

Healthy House Merced United Way Merced County

Human Services Agency Merced County Valley Children's Hospital

Livingston Community Health

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Appendix C: Top Health Priorities from Community Meetings Meeting Location

Participants Most Important Health Condition

2nd Most Important Health Condition

Most Important Health Issue

2nd Most Important Health Issue

District 1

Planada (Spanish/English)

15 Heart Disease & Stroke

Tie: Heart Disease & Stroke, Lung Disease



Livingston (Punjabi/English)


Diabetes Health Food & Physical Activity


District 2

City of Merced 16 Diabetes Diabetes Income, Education, and Employment

Healthy Food & Physical Activity

District 3

Atwater 10 Heart Disease & Stroke

Drug & Alcohol Abuse



Franklin-Beachwood

13 Drug & Alcohol Abuse

Diabetes Income, Education, and Employment


District 4

Winton 12 Drug & Alcohol Abuse

Diabetes



Gustine 9 Heart Disease & Stroke

Heart Disease & Stroke

Chronic Lung Disease

Diabetes (Tied)



District 5

Los Banos 7 Heart Disease & Stroke

Tie: Heart Disease &Stroke, Drug & Alcohol Abuse, Diabetes


Tie: Injury &Violence, Healthy Foods & Physical Activity

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Meeting Location

Participants Most Important Health Condition

2nd Most Important Health Condition

Most Important Health Issue

2nd Most Important Health Issue

Population-Specific Meetings

Latino Community Meeting at Golden Valley Health Center, South Merced (Spanish/English)




Housing and Homelessness

Monolingual Hmong Community Meeting


Diabetes Income, Education, and Employment


Transitional Age Youth Meeting

15 Diabetes Heart Disease & Stroke



LGBTQ Meeting 6 Drug & Alcohol Abuse

STIs Access to Health Care

Tie: Income, Education, and Employment; Healthy Foods & Physical Activity

Health Care Consortium


Diabetes Income, Educations, and Employment


African American Community


Heart Disease & Stroke

Income, Educations, and Employment


Department of Public Health staff



Income, Educations, and Employment

Healthy Foods & Physical Activity

Total number of community meeting participants: 251

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The Many Faces of Merced County

Merced County

Community Health Improvement Plan

www.countyofmerced.com/publichealth Resource Development Associates

http://www.co.merced.ca.us/publichealth

Documents

Merced County Community Health Improvement Plan