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WELCOME

DOUG JACKSONVIRGINIA DEPARTMENT OF HOUSING

& COMMUNITY DEVELOPMENT

Explore how NRV Community Health

Assessment findings relate to your work.

Learn how other communities are making

strategic investments to address identified

needs

Contribute ideas, experiences, and energy to

improve health and well being in the NRV.

TODAY WE’LL

BILL FLATTERYCARILION CLINIC

WELCOME +INTRODUCTION

STEPHEN CHANDLER

LEWIS GALE

WELCOME +INTRODUCTION

ASHLEY HASHCARILION NEW RIVER VALLEY

MEDICAL CENTER

COMMUNITY HEALTH ASSESSMENT

MICHELLE BRAUNSCOMMUNITY HEALTH CENTER OF THE

NEW RIVER VALLEY

COMMUNITY HEALTH ASSESSMENT

SYSTEMS AT WORK

DOUG JACKSONVA DHCD

SYSTEMS AT WORK

TAKEAWAYS

SYSTEMS AT WORK

JESSICA WIRGAUCOMMUNITY FOUNDATION OF THE

NEW RIVER VALLEY

SYSTEMS AT WORK

DOUG JACKSONVA DHCD

SYSTEMS AT WORK

TAKEAWAYS

WEIGHING IN BYMOVING ABOUT


Which of the CHA priorities do you perceive to be the greatest barrier for your clients/citizens?

1

A. Access to Care

B. Affordable, Safe Housing

C. Child Abuse / Domestic Violence

D. Culture: Healthy behaviors not a priority

E. Lack of knowledge of resources

F. Poverty / low avg. household income

G. Substance Use

H. Transportation

GREATEST BARRIER


If we could address one priority area, which one do you think would have the greatest impact on

our region?

2

A. Access to Care






G. Substance Use

H. Transportation

GREATEST IMPACT


Which priority do you think there is the greatest energy

to work on?

3

A. Access to Care






G. Substance Use

H. Transportation

GREATEST ENERGY

SYSTEMS AT WORK

JEFF DINGERGILES COUNTY

SYSTEMS AT WORK

TAKEAWAYS

SYSTEMS THINKING

SYSTEMSTHINKING

mycorrhizal

networks

SYSTEMSTHINKING

SYSTEMS SYSTEMS THINKING SEEING

The glaringly obvious only glares at you

after you see it.

First Steps Information Sharing NetworkShared ResourcesService DeliveryJoint Planning

2016 2019

SYSTEMSTHINKING

The network as part of a system, actively engaging in the system by

understanding it.

LEARNING TOGETHER


SYSTEMIC

SYSTEMSTHINKING

SYSTEMSTHINKING

Get it at

donnellameadows.org

SYSTEMSTHINKING

Learn to read causal loops at

systemsandus.com

SYSTEMSTHINKING

But what are we trying to identify in the system?• Overlooked resources

• Missed perspectives

• Nontraditional partners

• Norms

• Patterns

• Synthesis over analysis

• New frames of reference

• Complexity!

• Feedback patterns

• Environmental inputs

• Leverage points

• Policy implications

SYSTEMSTHINKING

Learn to read causal loops at

systemsandus.com

“We’re disrupting how we think about the community.”

Jessica Wirgau

“Then we get them all together.

Chris McKlarney

BARRIERS & LEAPS

DR. NOELLE BISSELL, M.D.

NEW RIVER HEALTH DISTRICT

DR. NANCY WELCH, M.D.CHESAPEAKE HEALTH DEPARTMENT

DANIELLE PORZIGHEALTHY CHEASAPEAKE

KEYNOTE SPEAKERS

12/18/2019

Healthy ChesapeakeA Unique Partnership for Addressing Population Health Needs

New River Presentation| November 2019

Danielle Porzig, MPH, Healthy Chesapeake CARE Program Manager

Nancy Welch, MD, MHA, MBA, Chesapeake Health District Director

• Chesapeake City had declined to 44th per the

annual Virginia RWJF County Health Rankings

• Recent joint Community Needs Assessment

conducted by the health department and hospital

indicated specific focus areas for improvement

• Data analysis showed large disparities in segments

of our community

• Now it is 37

Declining community health status drove

the formation

What are the most important HEALTH-RELATED ISSUES for our entire community?

Options Response

Count

Percent

Mental health (depression, anxiety, stress) 92 60.9

Aging 73 48.3

Clean & healthy environment 65 43.0

Nutrition (healthy food and eating habits) 59 39.1

Obesity 58 38.4

Disabilities (physical, intellectual, sensory,

developmental)

53 35.1

Chronic Diseases (such as heart disease or diabetes) 52 34.4

Alcohol and drug abuse 50 33.1

Infectious diseases (such as flu or tuberculosis) 40 26.5

Healthy babies and mothers 36 23.8

Dental health (healthy teeth) 36 23.8

Immunizations 31 20.5

Tobacco Use 29 19.2

Sexually transmitted diseases 25 16.6

Accidental injuries 14 9.3

7

7

Data Shows Large Disparity Gaps

within the city

Low Health Opportunity = BAD

Health Opportunity Index (HOI) Factors

also show big differences

VDH calculates a Health

Opportunity Index, or

HOI, which is a composite

measure comprised of 13

indices that reflect a broad

array of social determinants

of health affecting the

community.

We are electing to work in

low HOI areas initially

where the impact

opportunity is the greatest.

Population Health Issues in

Chesapeake

• Food InsecurityThere are an estimated 26,630 food insecure individuals in

Chesapeake1

• Diabetes PrevalenceAt 15%, Chesapeake is 1.5 times the state average2

• Adult Obesity Prevalence1 in 3 Chesapeake adults are obese3

• AgingThere is an expected 114 percent increase in the population

65 years + projected by 20404

Source:1 Feeding America: Map the Meal Gap 20182,3 Virginia Department of Health, 20154 Welden Cooper Population Center for Public Service, UVA

A small working group with two representatives

from the City and two from Chesapeake Regional

Medical Center, under the leadership of the Health

Director strategized the development of a unique

concept that eventually became Healthy

Chesapeake, Inc.

How to address these community health

needs?

• Inaugural interest meeting for development of Coalition led by Mayor

Krasnoff and Health Director, Dr. Nancy Welch

Community leadership buy-in critical

Broad Group of Initial Stakeholders

Internal and External Focus Group

Meetings = Initial Direction

Harbour North Focus Group Meeting Cambridge Square Focus Group Meeting

Coalition Strategic Planning

• The Health Director serves as the public health advisor for the Board

Decision to establish a unique hybrid

operating relationship

Chesapeake Health

Department

Director serves as

Public Health

Advisor

The Healthy Chesapeake Executive Director is contracted and

participates in strategic planning and liaisons with other Health

Department units for integration opportunities

Mission – Healthy Chesapeake is committed to building a culture of wellness that

supports, sustains, and advocates for a healthier Chesapeake

Vision – To be ranked the healthiest community in Virginia per the Robert Wood Johnson

County Health Ranking

Board – Board of Directors that provide the guidance and financial oversight of our

program initiatives

Coalition – Voluntary group of citizens, community agencies, city

departments, faith-based organizations, health care providers, and

others that collaborate on direct service delivery

501(c)(3) – Established and operational with an Executive Director reporting to the Board

and administrative and programmatic staff that support the Coalition

Strategy – Facilitate and provide support for population health

programs and services developed and delivered by the Coalition in

response to priorities identified by Community Needs Assessment,

Chesapeake Neighborhood Quality of Life Study, Chesapeake

Comprehensive Plans for Youth and 55 and Better, etc.

Chesapeake Responds: Healthy

Chesapeake

85

• Healthy Chesapeake, Inc. is designated by the Chesapeake Health District and approved by VDH as the population health manager to lead the response to Virginia’s Plan for Well Being.

• Healthy Chesapeake, Inc. is charged with providing and ensuring: “…coordination and collaboration of all sectors of the community government, health care, education, businesses and community organizations including the faith based .. in working together to improve the conditions needed for people to be healthy.”

Unique Contractual Relationship

with The Chesapeake Health District

Plan created by statewide multi-

faceted taskforce to address

population health issues in Virginia.

• This Memorandum of Agreement between Chesapeake Health Department (CHD), and Healthy Chesapeake, Inc. (HCI), for the purpose of cooperation and coordination related to the implementation of strategic initiatives related to improvement of the population health of Chesapeake.

• WHEREAS, in 2017 HCI was designated the population health manager for CHD with responsibility to implement the Plan for Wellbeing in Chesapeake.

• CHD Responsibilities1. Subject to appropriation for CHD budget and contingent on

available non-designated funding, the CHD agrees to disburse funds in support for the operation of HCI and the delivery of population health programs and services.

2. The CHD Health Director shall serve as a non-voting Public Health Advisor to the board and coalition.

MOU with Healthy Chesapeake

A unique hybrid/lateral structure is established by the corporate

bylaws and outlines the operating process.

Important Roles

Shared MissionHealthy Chesapeake

Board

Healthy Chesapeake

Coalition

Collective Impact Premise

• The Coalition is a separate entity with its own chair

and operating structure that includes work teams

consisting of internal and external stakeholders

• The Coalition is lateral to the Board and drives the

direction of the programs that are then financially

supported by the Board

• The Board has two voting members from the Coalition

that reinforce program priorities

• The Executive Director is an experienced community

and economic development professional that

facilitates the relationship between the two entities

Uses the Collective Impact Model

1. Expanded the knowledge base of partners and community officials to focus on population health.

2. Expands population health response capacity with a 40+ member coalition instead of a single staff member.

3. Brings broad breadth of expertise to bear via coalition participation.

4. Extends the ability for leveraging resources

5. Reduces administrative processes and restrictive purchasing.

6. Improves the ability for resource gathering via in-kind, tax deductible giving and grant-writing eligibility.

7. Better able to serve as a neutral facilitator.

8. Allows the external contractual relationships of the Health District be extended to Healthy Chesapeake via MOU’s.

Benefits of a Nonprofit as a Health District

Population Health Manager

Public Health is a Community Value

Two years after establishment and extensive community

collaboration and projects, the city was approached for

financial support.

City Council approved 15 cent per pack increase in cigarette tax

and earmarked it for public health projects with

6 cents directed for Healthy Chesapeake, Inc.

This unique allocation for community-led health initiatives and

provides Healthy Chesapeake on-going organizational stability.

Chesapeake… the city that cares!

City of Chesapeake Support

As a founding partner of Healthy Chesapeake, Chesapeake Regional Healthcare has

been a linchpin for this city-wide effort. With a focused commitment to addressing

population health, this regional hospital has continued to provide resources,

guidance, and engagement in all facets of Healthy Chesapeake. It has leveraged

both financial and in-kind resources to enable this effort to develop.

Chesapeake Regional Healthcare

• Program Support:

❖ Diabetes and Hypertension Community-based Response HUB in high

risk area with staffing and supplies

❖ Purchase and renovation of Community Food Farmacy projected at

$375,000 when completed Fall 2018

• Participation of Staff on Board and Coalition in-kind donation of

$75,000 annually

❖ Board: Vice President of Operations

❖ Coalition: Vice-chair of Coalition

❖ Coalition: Mental Health & Community Ambassador work

team leadership

• Space and Webhosting in-kind donation of over $40,000 annually

❖ Provision of Healthy Chesapeake Office Space, usage of board

and training space, and on-going web hosting

CRH Engagement with

Healthy Chesapeake

ODU through an MOU assumed the leadership role in gathering and

performing the external review and evaluation for all Healthy

Chesapeake projects.

Old Dominion University

• Volunteer Management Policy

initial draft

• Financial Management Policy

initial draft

• Program Policies and

Procedures initial draft

• Administrative Data Analysis

• Coordination of the SPARK Pilot

Project

• IRB development for Cooking

Class Program evaluation

• Individual gardening project

evaluation

• Youth employment program

development and evaluation

• An overview of evidence-based

chronic diseases prevention

programs in Virginia and

descriptions

• Healthy Chesapeake Program

Evaluation (assistance w/

instrument research)

• Active Lifestyle Phone Surveys

and compilation of data

• Baby Care Project Evaluation

• HUB Medical Intervention Data

Collection

• Family Planning Program

Evaluation

• Functional Food Project

Development

• Assessment of transportation

services provided by free clinics

• FAMIS project with DVH

through Chesapeake Health

Department

Healthy Chesapeake & ODU

Academic Evaluations/Research

FREE Diabetes prevention and management program

within high risk communitiesIncludes: Transportation, Testing, Cooking School, Social Work, and Food

distribution through Food Farmacy

PARTNERS: CRH, Health Department, Fire Department, Liberty Street Clinic,

Chesapeake Care Clinic, Cooperative Extension, Foodbank, American Diabetes

Association, Norfolk State University, Community Churches

Plan for VA

Well-being

Aims 3 & 4

The HUB

Diabetes and Hypertension Center

Need Providers

Client referrals Southeastern Virginia Health System

Chesapeake Care Clinic

Free, frequent medical checks at site

location

Chesapeake Regional Healthcare

EMS, City of Chesapeake

Medical supplies and equipment

provided

Access Partnership

Chesapeake Care Clinic

Social work referral assistance Norfolk State University

Kin and Kids Consulting

Wellness coaching Chesapeake Health Department

Fresh food access Healthy Chesapeake

Education Chesapeake Health Department

American Diabetes Association

Transportation assistance To be contracted

99

Case Study: Diabetes and

Hypertension Management (HUB)

Services and service providers confirmed

100



• Healthy Chesapeake sought and received funding from Hampton Roads Community Foundation: $147,750 over 3 years

• HUB program launched

• External evaluation performed during pilot phase by the ODU Center for Global Health

101



Outcome: Decrease in hospitalizations and ER visits

0% 10% 20% 30% 40% 50% 60% 70% 80%

Any Hospitalization in the past 12

months before starting Hub

Any ER Visit in the past 12 months

before starting Hub

Any ER Visit in the past 9 months

since starting Hub

Any Hospitalization in the past 9

months since starting Hub

Source:

Healthy Chesapeake, Summary of Findings, ODU Center for Global Health, April 2019



102

Source:


Outcome: Decrease in mean A1C

Outcome: Decrease in mean arterial pressure

103



Source:


Outcome: Improved healthy eating and active lifestyle

behaviors

104



0% 20% 40% 60% 80% 100% 120%

Daily Fruits and Vegetables

Consumption

Daily moderate sport for at least

10 minutes

Daily water consumption

At 9 Months Baseline

Source:


105

Active Coalition Partners and Program

EngagementActive Coalition Partners and Program

Engagement

Active Coalition Partners and Program Engagement

• Volunteer Management Policy

• Financial Management Policy

• Program Policies and Procedures

• Administrative Data

• Coordination of the SPARK Pilot Project

• IRB development for Cooking Class

Program evaluation

• Individual gardening project

development

• Youth employment program

development

• An overview of evidence-based chronic

diseases prevention programs in

Virginia and descriptions

• Healthy Chesapeake Program Evaluation

(assistance w/ instrument research)

• Active Lifestyle Phone Surveys

• Baby Care Project

• HUB Data Collection

• Family Planning

• Functional Food

• Assessment of transportation services

provided by free clinics

• FAMIS project with DVH through Chesapeake

Health Department

Healthy Chesapeake ODU Projects

Opportunities for individuals to grow their own food or have access to healthy foods. Sites at

community and senior locations managed by the residents and production sites at churches and

schools.

Pending Project : 22 Acre research, teaching and production site

Healthy Food Access

Goal: Provide the knowledge and

skills on how to eat healthier

❖ Healthy Chef is a multi-part cooking school on how to cook healthier.

❖ Use mobile cooking stations

❖ Grant PARTNERS:

✓ Hampton Roads Community Foundation

✓ The City of Chesapeake Social Services

✓ Southeast Virginia Community Foundation.

AIM 3

Utilization of Healthy Foods

Extension Agent teaching Healthy Chef class for seniors

Healthy Chesapeake convenes and

facilitates, but the Coalition partners take

ownership!

See the Concept in Action

Strategy: Utilize the VA Plan for Well-Being Goals and Strategies as the

operational framework:

• AIM 1: Healthy Connected Communities

– Expand training and work-linked learning opportunities

– Virginia adolescents choose not to engage in behaviors that put their well-being at risk

• AIM 2: Strong Start for Children

– Form neighborhood collaborative co-led by community members in under-resourced

communities to identify obstacles and develop plans to address the root causes of

health inequities

• AIM 3: Preventative Actions

– Virginians follow a healthy diet and live actively

– Virginians have lifelong wellness

– Expand opportunities during and after school for children to get healthy meals and the

recommended amount of daily physical activity

– Increase access to healthy and affordable foods in all neighborhoods

– Expand programs and services eliminate childhood hunger

– Help people recognize and make healthy food and beverage choices

– Increase access to internet usage for aging Virginians

• AIM 4: System of Health Care

– Virginia has a strong primary care system lined to behavioral health care, oral health

care and community support systems

– Virginians obtain, process, and understand basic health information and services

needed to make appropriate health decisions

VA Plan for Well-Being as a

Healthy Chesapeake Action Guide

• County Health Rankings are used as directional benchmarks.

• Virginia Plan for Well-Being correlated with the County

Health Rankings.

• The Chesapeake Community Action Plan and Community

Health Needs Assessment currently conducted in

conjunction with hospital.

• The RU Ready comprehensive plan, the 55Plus

comprehensive plan and the cities 2030 plan are also

integrated.

Melding of local, state & national priorities

striving for goal of health in all policies

*A Food Farmacy in a low HOI area with Chesapeake Regional

Hospital.

PARTNERS:• Foodbank

• Farmers Market

• Local Farmers

• Healthy Chef Cooking School

• Youth Employment

• Non-profit Buffalow Family and Friends

• Health Department

Healthy Foods Access Site Plan for VA

Well-being

Aim 1

Concept drawings

*in process

Health Ambassadors and Support of

Neighborhoods

Voices for the community and serve on our

work-teams

This Fall initiate Diabetes and Hypertension

Pilot

PARTNERS:

• African American Churches in low HOI

• NC State Faithful Families curriculum

Engaging with

the community

is vitally

important!

Peer-to-peer is a long-proven effective strategy

VOICES from the community

Plan for VA

Well-being

Aim 1

Goal: Virginians Follow a Healthy Diet and Live Actively

SPARK senior and youth do and learn program-expands free meal program, social engagement, and wellness activities.

PARTNERS:

▪ Chesapeake Libraries

▪ School Nutrition Program

▪ Senior Services of Southeast VA

▪ 15 other service providers

of various activities

Active Lifestyles - SPARK

1. Continue to build Coalition

2. Improve internal and external communications

3. Enhance advocacy role

4. Adjust to evaluation findings

115

Next Steps

5. Determine need and role in addressing other social determinant

issues; i.e.., transportation, housing, etc.

6. Expand beyond pilot areas

116

Next Steps

Buying Motivation: Do You Actually Buy

Products?

• Fashion: Purchased to look better, feel more valued, have

greater confidence, fit in/stand out.

•Books/Information: Bought to further education, feel

more intellectual, gain understanding, escape reality.

•Furniture: Purchased for comfort, security, greater self-

esteem and aesthetics.

•Food: Bought for the experience, self-esteem, body-

consciousness (e.g. diet food).

The Pepsi Generation Story

Lets go back to 1960’s America for a few minutes.

Set The Stage

1.The youth of the day were fighting for liberation, equality and

battling against the restrictions put in place by the previous generation.

…Afros, bell-bottom jeans, mini-skirts, lava lamps and tie dye t-shirts

were all the rage.

…Things were getting- how can I put this- groovy.

2. And there was one company dominating the soft-drink industry, Coca-

Cola. They were outselling their nearest competitor, Pepsi, by almost 6 to

1.

3. They’d used branding and advertising to promote themselves as a representative of everything that made American’s proud to be American- wholesome values, tradition and national pride.

Advertising

• Alan Pottasch, decided that the brand should stop talking about

their product and instead, start talking about the user

• …and more specifically, those who saw themselves as different to the previous generation.

The Pepsi Generation

In 1963 Pepsi launched an ad campaign named The Pepsi Generation.

• Pepsi took a huge chunk of Coca-Cola’s market share. The campaign had successfully advertised the type of person who bought their

product, INSTEAD of their product (which was almost identical to their

biggest rivals).

Buying Motivation: Anybody Can Harness It

• Social media offers brands the perfect opportunity to target their

ideal market for very low costs…

• The key selling point of your product, is not actually your product, it’s what it can help your customer achieve.

• …and all these things add up to one thing: a better version of

themselves.

• People don’t buy products, they buy what the product will do TO them.

https://www.einsteinmarketer.com/customer-avatar-target-market/

Shift Your Focus

The first thing you need to do is shift your advertising focus away from

your product and put the spotlight on your target market.

Whilst a beginner would spend all their time and focus

advertising the second step (the product), an experienced

advertiser would primarily focus their efforts on the difference

between step 1 and step 3.

Coalition Workteams

124

Current and developing programs

Health Behaviors

Diet and Exercise

Healthy ChefElizabeth Gorimani-Mundoma

Garden2Table Mike Andruczyk

Food Farmacy

FITBenjamin Camras

Clinical Care

Access to Care

HUBMary Trosien

Mental Health

Social and Economic

Education

Employment

Family and Social Support

SPARKKathryn Jesse

Volunteer (MRC)Thomas Johnson

Faithful Families

County Health Rankings

0

10

20

30

40

50

60

2014 2015 2016 2017 2018

RA

NK

ING

WIT

HIN

ST

AT

E

Chesapeake Trend Depictions

Health Outcomes Health Factors Quality of Life

Health Factor/Behaviors

Adult Obesity

Physical Inactivity

Access to Exercise

Opportunity

Alcohol Related Deaths

STD

Teen Births

Drug Overdose Deaths

County Health Rankings

0

10

20

30

40

50

60

2014 2015 2016 2017 2018

RA

NK

ING

WIT

HIN

ST

AT

E

Chesapeake Trend Depictions

Health Behaviors Clinical Care Soc & Econ. Factors Length of Life

Clinical Care

Social & Economic Factors

Uninsured

Primary Care Physician Ratio

Dentist Ratio

Mental Health Provider Ratio

Mammogram Screening

Violent Crime

Injury Deaths

Median Household Income

Children reduced lunch

Strategic Plan Development

Healthy Chesapeake Programs

• 11 community, production or learning gardens,

including a garden and training program for

Chesapeake Correctional Center female inmates

• 50 individual grow box projects for low-income

individuals

• Seedbank launched to provide community

gardens and individuals with free supplies

129

Year One Highlights: Garden2Table

• Launched faith-based wellness program (Faithful

Families)

• Sponsored 10 youth and 2 senior stipends to

support community programming

• Supported community events, trainings, and

learning activities for more than 1500 individuals

130

Year One Highlights: CARE

https://www.odu.edu/hs/centers/globalhealth

https://www.odu.edu/hs/centers/globalhealth

Public health is not a department but rather a community value

For More Information:

Dr. Nancy Welch, Health Director

Chesapeake Health District

[email protected]

Dr. Wendy Schofer, Coalition Co-Chair

[email protected]

mailto:[email protected]

mailto:[email protected]

SYSTEMS AT WORK

DOUG JACKSONVA DHCD

SYSTEMS AT WORK

TAKEAWAYS

SYSTEMS AT WORK

TINA KINGNEW RIVER VALLEYAGENCY ON AGING

SYSTEMS AT WORK

TAKEAWAYS

SYSTEMS AT WORK

DOUG JACKSONVA DHCD

NEXT STEPS

DOUG JACKSONVA DHCD

NEXTSTEPS

NEXT STEPS

What key institutions or organizations (or type of

institutions or organizations) do you believe are critical in

providing stewardship for our collective next steps?

1

NEXT STEPS

What are the two top things you’d ask the

steering team to pursue as initial steps?

1

KEVIN BYRDNEW RIVER VALLEY

REGIONAL COMMISSION

WRAPUP

DR. NOELLE BISSELL, M.D.

NEW RIVER HEALTH DISTRICT

CLOSING

THANK YOU

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