GR2011-12 Advancing the Integration of Community and Clinical Preventi

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www.preventioninstitute.org Larry Cohen, MSW Executive Director Highland Hospital, Oakland, CA December 2, 2011 Advancing The Integration of Community & Clinical Prevention

Prevention Institute: 

Prevention Institute Preventing violence and reducing injury Reforming our health system Supporting healthy food and activity environments Improving environments for health and health equity Promoting mental health and well-being

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Prevention a systematic process that reduces the frequency and/or severity of illness or injury. Promotes healthy environments and behaviors to prevent problems from occurring before the onset of symptoms Prevention Primary Prevention Primary Prevention

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HEALTH & SAFETY BEHAVIOR BEHAVIOR EXPOSURES ENVIRONMENT

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Photo credit: Childhood Obesity Prevention Coalition, Washington State

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Photo courtesy of Latino Health Access

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Photo courtesy of Latino Health Access

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Photo courtesy of Latino Health Access

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Photo courtesy of http://spacedust.atspace.com/soccer_archery.html

The Trajectory of Health and Health Inequities: 

The Trajectory of Health and Health Inequities EXPOSURES & BEHAVIORS HEALTH CARE SERVICES ENVIRONMENT A Key Opportunity for Prevention INJURIES, ILLNESS & INEQUITIES

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It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. “ ” Institute of Medicine

MOVING UPSTREAM: 

M OVING U PSTREAM “ We are still standing on the bank of the river, rescuing people who are drowning. We have not gone to the head of the river to keep them from falling in. That is the 21st century task. ” Gloria Steinem Photo Source: http://static.flickr.com/90/207590972_a30260c293_b.jpg

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Take 2 Steps to Prevention Health Care Services Exposures & Behaviors Environment

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Photo Credit : http://myweb.stedwards.edu/caleman/crime%20scene.jpg

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Photo courtesy of http://tycohealth-ece.com/files/d0003/ty_rn33d7.jpg

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Not the primary determinant of health Treats one person at a time Often comes late; can’t always restore health Medical Care Alone Cannot Reduce Injuries and Inequities

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The 1 st step ... Health Care Services Exposures & Behaviors Environment

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Let’s take another step ... Health Care Services Exposures & Behaviors Environment

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What’s Sold and Promoted

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Liquor Store Closings Los Angeles, CA Zoning ordinance s s hut down 200 liquor stores in 3 years. An average 27% reduction in crime within a four-block radius of each closed liquor outlet.

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Links Between Violence and Health

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www.preventioninstitute.org/UNITY UNITY City Network Oakland San Diego Tucson Seattle Minneapolis Detroit Denver St. Louis Chicago Louisville Boston Newark Los Angeles New Orleans Nashville Philadelphia Cleveland Richmond Houston (San Jose)

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“UNITY is an initiative on a national level that brings us all together. That way we have greater power to focus our individual efforts so they’re not piecemeal.” — Commander JT Turner Tucson Police Department, Arizona www.preventioninstitute.org/UNITY

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Who? Partnerships High -Level Leadership Collaboration & Staffing Community Engagement What? Prevention Programs , Organizational Practices & Policies Communication Training & Capacity Building How? Strategy Strategic Plans Data & Evaluation Funding UNITY RoadMap www.preventioninstitute.org/UNITY

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Adopted the Blueprint for Action: a Multi-Sector Plan for Prevention. 64 percent decrease in homicides of young people aged 15 to 24 years . Number of youth suspects in violent crimes dropped by 62 percent. Coordinated Approach Minneapolis, MN

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“Violence is not the problem of one neighborhood or group…Coming together and owning this problem and the solutions are central.” -Dr. Deborah Prothrow-Stith , Harvard School of Public Health, UNITY Co-Chair Community-wide Framework for Preventing Violence

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What’s Sold and Promoted

Elements of Community Health: 

What’s sold & how it’s promoted Elements of Community Health PLACE

Elements of Community Health: 

Social networks & trust Participation & willingness to act for the common good Norms/Costumbres Racial justice Jobs & local ownership Education What’s sold & how it’s promoted Look, feel & safety Parks & open space Getting around Housing Air, water, soil Arts & culture Elements of Community Health PEOPLE PLACE EQUITABLE OPPORTUNITY Preventative services Access Treatment quality, disease management, in-patient services, & alternative medicine Cultural competence Emergency response HEALTH CARE SERVICES

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Health Services Prevention

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Improve health outcomes overall Advance equity Reduce health care demand and costs Shared Goals: Community Prevention & Health Care

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Health Services Prevention Integrated Approach

Community-Centered Health Homes: 

Community-Centered Health Homes

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A Different Way to Think about Health Care

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“The last time we looked in the book, the specific therapy for malnutrition was food.” Jack Geiger, MD

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Community-Centered Health Homes Patient-Centered Health Homes Medical Homes

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Transferable to Community Prevention Existing Clinician Skills Patient Intake Diagnosis Treatment Capture and identify population level health trends Analyze and prioritize relevant community conditions Engage in advocacy and translate clinic priorities into action Inquiry Assessment Action

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I nquiry A ssessment A ction E nvironmental & P olicy C hange C OORDINATED C LINICAL & C oMMUNITY P REVENTION A CTIVITy I dentify P riority H ealth I ssues C omprehensive S trategy D evelopment P ARTNERSHIP F ORMATION Health Care Public Health Community Organizations D aTA C OLLECTION Clinical/Community Population Health Intervention Model O UTCOMES Improved Health Cost Savings Evidence-Base for Effective Practice

Inquiry: 

Inquiry Collect data on social, economic, & community conditions

Inquiry: 

Aggregate symptom and diagnosis prevalence data Inquiry

Assessment: 

Assessment Photo credit: Healthy City Systematically review health and safety trends

Assessment: 

Assessment Identify priorities and strategies with community partners

Action: 

Establish model organizational practices Action

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Action Advocate for community health

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Tool for Health Care Institutions to Identify Assets & Roles

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Collaborator 4 Expertise / Resources: Anticipated Outcomes: Key Strategies: Collaborator 3 Expertise / Resources: Anticipated Outcomes: Key Strategies: Collaborator 1 Expertise / Resources: Anticipated Outcomes: Key Strategies: Collaborator 2 Expertise / Resources: Anticipated Outcomes: Key Strategies: Shared Outcomes Partner Strengths Joint Strategies/ Activities Collaboration Multiplier

Local Capacities Needed: 

Local Capacities Needed Staff training and continuing education A dedicated and diverse team of staff Innovative leadership

Overarching Systems Change Recommendations: 

Overarching Systems Change Recommendations Structure health care payment systems to support CCHHs Leverage current opportunities for government, philanthropy, and community benefits to support CCHHs Consistent metrics for evaluation and continuous quality improvement Networks to support peer-to-peer learning A cadre of health professionals prepared to work in CCHHs

Sustainability: 

Sustainability "In our every deliberation we must consider the impact of our decisions on the next seven generations." (Great Law of the Iroquois Indian Confederation) "We can either be victims of change or we can plan for it, shape it, and emerge stronger from it. The choice is ours." (Sonaran Institute)

TOOLS: 

www.preventioninstitute.org TOOLS

The Spectrum of Prevention: 

Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education The Spectrum of Prevention Strengthening Individual Knowledge & Skills

Community-Centered Health Homes: 

Community-Centered Health Homes

Rapid Response Media Network: 

Rapid Response Media Network Gives advocates the tools to shape public discussion on nutrition and physical activity from the ground up—starting in their own community. Soda Menu Labeling Marketing to K ids Joint Use Healthy Food Retail Transportation Health Reform http ://www.preventioninstitute.org/alerts

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www.preventioninstitute.org/UNITY

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221 Oak Street Oakland, CA 94607 Tel: (510) 444-7738 Sign up for our media alerts: http://www.preventioninstitute.org/alerts www.preventioninstitute.org Follow us on: