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The Garrett County Planning Tool

State: MD Type: Promising Practice Year: 2018

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Garrett County Health Department
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The Garrett County Planning Tool
Our local health department serves a rural population size of approximately 29,460 people in the westernmost corner of Maryland. Garrett County is comprised of a homogenous and aging population (US Census, 2014). The economic disparity between Garrett County, the rest of Maryland and the United States is striking. The US Census states that 12.4% of people live in poverty, and 19.7% of Garrett County children under 18 years old are in poverty, compared to the average rate of 10.7% throughout Maryland. Maryland was ranked among the wealthiest three states, with an average household income of $73,971. Garrett County is well below that at $46,096. Our greatest public health issues stem from the lack of economic dignity that at least 1/3rd of our residents experience. Lack of access to health services continues to be an issue in our area. This is demonstrated in a variety of ways both traditionally by the lack of public transportation available and lack of specialty care to broader issues, like the lack of digitally enabled people and fragmented safety net systems. One of our charges at the local health department is to develop a Community Health Improvement Plan that is responsive to the needs of the people based on the data we've collected and analyzed. The Health Planning Unit created The Garrett County Planning Tool, and in twelve months radically transformed the way our community collaborates to improve health. The Garrett County Planning Tool is intended to help communities create a local, data-informed vision about their current needs by meaningfully and transparently engaging all residents. This vision becomes actionable through the digital framework by providing the platform for the creation of a comprehensive and responsive community health improvement plan. Health equity through community engagement is an important element for health departments initially seeking or maintaining accreditation by demonstrating high-performance through accountability and credibility with all stakeholders; our agency partners and the community at large. These are essential elements to sustaining a robust public health system that is responsive to the needs of all residents. The digital framework guides agencies through the process of creating a measurement framework to ensure the strategies they use to improve health in a community have metrics that specifically align with the strategy they have identified. The ultimate goal being that specific strategies measured as hyper local data becomes the primary method of program attribution. Though relatively nascent as a concept, the Robert Wood Johnson Foundation recognized the digital collaborative for community health improvement processes as a central component in the 2017 Culture of Health award for Garrett County. In addition, with competitive funding earned from PHNCI, Garrett County's planning tool has been released as an open source, replicable framework. Objectives include: Enroll 500 individuals as community health planners by June 30, 2017. Participation will meet or exceed 500 discussion posts by June 30, 2017. Collect user records for 10% of Garrett County's population by June 30, 2017. At least 25 groups will be created by multisectoral partners. Develop 5 evidence-based multisectoral strategies by January 1, 2018. At least 10 data collection points will be utilized to track progress of identified community strategies by January 1, 2018. A representative Community Health Improvement Plan will be written by Jan 1, 2018. The Garrett County Planning Tool, built internally under GPL v3 licensing, went live on November 10, 2016 as a soft launch in-house with a few champion stakeholders. The public launch occurred on Dec 1, 2016. Activities have included on-boarding members, posting content, fostering and analyzing discussions, collecting and analyzing analytics, publishing the strategy card and raw data modules to aid the community in choosing strategies that can be measured for the collection of hyper local data. Data from groups involving multisectoral collaboration has been collected and analyzed for the creation of the first digital & responsive community health improvement plan. Results/Outcomes far exceeded the objectives originally set by the health planning unit. Members: June 30, 2016 - 1,431 Dec 1, 2017 - 1,759 Discussion Posts June 30, 2016 - 788 User Records June 30, 2016 - 5,121 Dec 1, 2017 - 13,363 Groups Dec 1, 2017 - 101 Strategies Dec 1, 2017 - 7 Primary Data Points Dec 1, 2017 - 90 Representative Community Health Improvement Plan Jan. 1, 2018 - In progress! Impacts in practice include the revolutionization of community health planning processes through replication and sustaining public health as we know it. URL https://mygarrettcounty.com
Nationally accredited local health departments are required to conduct a Community Needs Assessment and address those needs in a Community Health Improvement Plan. This plan is supposed to engage the community and improve our population health outcomes. The last iteration of the Community Health Improvement Plan for Garrett County had less than ½ of 1 % of the total population involved in the process. Those that were involved were the same directors and leaders that have written plans like these for decades with little to no input from the people who the plan is intended to serve. This is the type of bureaucratic practice that perpetuates the health inequities and disparities in a community. We found a way to increase equity and build capacity exponentially in our county. Once our residents were aware of the two major community process their local health department conducted we needed to begin to address the second major issue, the lack of local data available to accurately measure our communities health status at any given time. Accurate and timely data are essential elements in sustaining a robust public health system that is responsive to the needs of the community. In addition to unprecedented community engagement, The Garrett County Planning Tool framework guides agencies through the process of creating a measurement framework to ensure the strategies they use to improve health in a community have metrics that specifically align with the strategy they have identified. The ultimate goal being that specific strategies measured as hyper local data becomes the primary method of program attribution. Currently, local health departments rely heavily on population health data that relates to basic core demography and is often broad and unspecialized in nature, but provides an excellent lens to begin examining a population. However, these datasets upon their release are often at least two years old, and it becomes difficult for communities to attribute programmatic successes across such a span of time. So, if a goal of public health is to be truly responsive we need to ensure the strategies we are employing in communities are indeed successful and do that they need to be accurately measured. Locally, the entire county is affected by the problem, 29,460 Garrett County residents. However, approximately 3,000 residents suffer in poverty and are our traditionally the most underrepresented in the County. In addition, we believe this problem is a fundamental flaw within the field of public health and this practice has the potential to transform community processes in health planning. We would like to reach at least 10% of the entire population. By June 30, 2017 we exceeded our goal and reached 17.4%, and further exceeded it by December 1, 2017 by engaging 45.4% of our entire population. For clarification, engagement in this sense has been measured as multiple actions completed by a specific user. Community engagement has traditionally been a challenge for government agencies. Often agency stakeholders serve multiple roles and claim community member resulting in reporting inaccuracies concerning engagement due to a lack of resident involvement. To date innovative ideas have not been explored to help mitigate the issue. In a government agency we have opportunities to build trust within the community. Creating a public space and willingly engaging in transparent conversations about issues, ideas and concerns with the residents to make the community a better place proves the agency and residents work as a team. The digital platform is a way to break down barriers and allow anyone to participate at any time throughout the planning process. Giving residents a way to share what matters to them and help create solutions for their community has demonstrated an increase in equity within Garrett County through health planning. Utilizing the planning tool to track the progress made from strategies collectively chosen brings the community health improvement plan to life. It shows real success and has a much greater impact in the community than previous efforts have demonstrated because the community has an active role in accomplishing certain aspects of the community health improvement plan. The sole aspect of hyper local data has proven to be a true game changer in our community as it's specialized, immediately actionable, attributable and collective. The Robert Wood Johnson Foundation, the Public Health National Centers for Innovation, and the Maryland Department of Health have all recognized the Garrett County Planning Tool as an innovation in the field of public health in 2017. Creating a planning tool using a combination of open source technology to become a responsive data collection powerhouse that simplifies and humanizes the health planning world that is actually affordable and available to other communities is indeed new to the field of public health. This tool is not yet an evidence-based practice but is considered an innovative practice. Iit does enable any community utilizing it to exceed all the requirements from the Public Health Accreditation Board concerning community engagement among many other things. This planning tool enables our county to collect terabytes of data about our population. It has built equity, increased representation and participation in community health improvement efforts. It walks agencies through the arduous process of choosing the right strategies and then becomes the central hub for evidence based strategies being implemented in the county, it actually measures multisectoral collaboration, it serves as our documentation management system for PHAB, is our performance management system, developed our community health improvement plan based on community buy in and there's a community dashboard and a data visualization feature for all the metrics entered into the framework. The best part is that multifaceted system is entirely free to other communities to replicate. This innovation is a non-conceptual, living framework that our community has been utilizing for one year and we can't wait until it becomes an evidence based practice!
Nutrition, Physical Activity, and Obesity|Tobacco|Teen Pregnancy
MyGarrettCounty.com is a digital community engagement collaborative implemented by the Garrett County Health Department with support from local stakeholders to increase connectivity & representation in planning processes, community engagement, and collection of hyper local data. Working as an incredibly dedicated team at the Garrett County Health Department in Oakland, Maryland, John Corbin and Shelley Argabrite are co-creators of the Garrett County Planning Tool. Originally inspired by the inadequacies of qualitative data analysis during the community needs assessment process, the Garrett County Planning Tool set out to dive deeper in understanding the complexities many people face when dealing with issues concerning their quality of life. The local health department fosters collaboration with community stakeholders by inviting them to participate in transparent processes digitally. By minimizing traditional barriers of inconvenient meeting times, lack of transportation, and social status stigma more residents have the opportunity to share their thoughts and opinions. The planning tool was built quickly with the first section titled discussions. It is in this section that the priorities of the needs assessment were listed and then the community had the opportunity to expand upon those identified areas. Essentially this became an extended focus group and was the beginning of our rich data collection. We wanted people to understand that their thoughts, concerns, and solutions were important and heard. This was an integral step in the success and early implementation of this practice. Transparently discussing anything people posted was so unique and refreshing for our rural appalachian community. We introduced mygarrettcounty.com internally to our health education and outreach unit and explained how to use the discussion section. The health planning unit posted first and within a few hours employees from health education and outreach began responding. It grew very quickly as the the community outreach workers introduced the planning tool to the residents of their specific communities within the county. We used gamification and other popular marketing concepts like continuous email marketing to encourage users to spread the word and help us grow the membership base. The health planning unit of the local health department introduced the concept to the Health Planning Council (HPC) which is comprised of multisectoral stakeholders ranging from leaders in healthcare to local business owners. This group convenes monthly and is charged with being the responsive entity as issues in the county arise relating to a resident's quality of life. This group was especially important as we on-boarded a range of agencies across the county. The HPC knew how valuable a tool like this would be at helping us collectively address long standing problems with fresh perspectives and was instrumental in on-boarding the employees of their respective agencies. Another critical partner during the first few months of implementation was our local community action agency. In order to ensure our most vulnerable residents were empowered to participate the health planning unit trained the coordinators using various methods including role playing. This training and the utilization of a social media login for members helped capture a population we had feared were digitally unenabled. We discovered over 6,000 people with our lowest socio-economic status were in fact digitally enabled and were using MVNO's that we could trace and helped us unlock more google analytics to dispel long held beliefs and incorrect assumptions about this population. There are many other examples of community collaboration demonstrated within mygarrettcounty.com. All 1,760 members have time and date stamped contributions to the collective work of health improvement. The documentation alone could be another submission. It is a true community collaborative that continues to grow and with each new active member changes the way our community addresses issues. Transparent dialogue between local health officials, agency stakeholders, and the general public continues to be a key component in improving equity and building capacity. Strategically investing in digital technologies allows people to collaborate more efficiently and work better as a team, which is helping us to achieve our desired outcomes. In the community discussion section of the adaptive planning tool found at mygarrettcounty.com, individuals have the space to openly discuss issues, concerns and suggest solutions to address what matters to them most. Community feedback on such a large scale has informed measure development and prioritization, marking an important step toward ensuring that measures reflect what is most important. Action groups were created to employ methods that will stimulate sustainable mobilization of the discussions in the forum and actualize strategies for community improvement. Within action groups, multisectoral partners work collectively on a strategy reporting incremental data that ensures responsiveness of the public health network in Garrett County. With well over 65,000 page views and 1,700 active planning partners in less than one year, the planning tool has completely changed the way our community conducts strategic health planning. What's most exciting is that we get to share this innovation with other communities! Our goal is to foster a culture of innovation in public health and successfully replicate and measure meaningful community engagement across our nation to improve health. The Garrett County Planning Tool is intended to help communities create a local, data-informed vision about their current needs by meaningfully and transparently engaging all residents. This vision becomes actionable through the digital framework by providing the platform for the creation of a comprehensive and responsive community health improvement plan. Objectives include: Enroll 500 individuals as community health planners by June 30, 2017. Participation will meet or exceed 500 discussion posts by June 30, 2017. Collect user records for 10% of Garrett County's population by June 30, 2017. At least 25 groups will be created by multisectoral partners. Develop 5 evidence-based multisectoral strategies by January 1, 2018. At least 10 data collection points will be utilized to track progress of identified community strategies by January 1, 2018. A representative Community Health Improvement Plan will be written by Jan 1, 2018. The Garrett County Planning Tool, built internally under GPL v3 licensing, went live on November 10, 2016 as a soft launch in-house with a few champion stakeholders as mentioned above. The public launch occurred on Dec 1, 2016. Activities have included on-boarding members, posting content, aiding discussions, and analyzing discussions, collecting analytics, and analyzing analytics, publishing the strategy card and raw data modules to aid the community in choosing strategies that can be measured for the collection of hyper local data. Data from groups involving multisectoral collaboration has been collected and analyzed for the creation of the first digital & responsive community health improvement plan to be published January 1, 2018. The creators of the tool did so during regular work time with no additional salary or any additional funding. As previously referenced, PHNCI awarded the health planning unit in July of 2018 with an innovation grant. The purpose of this funding is to help other communities replicate this practice with minimal staff and overhead. If an agency runs a website on a popular content management system and has a health planner this option is completely realistic with a very minimal budget.
The transitionary process invoked through the deployment of the Garrett County Planning Tool has empowered Garrett County leaders to utilize data in an unparalleled practice that incorporates hyper-localization lenses for analysis. Through this process, multisectoral partners have chosen to collaborate in a transparent space and uniformly report on a plethora of health priorities. This monthly reporting cycle provides access to actionable data that is responsive to trends within the community, creating what we've coined hyper local datasets. Moving forward, these datasets in combination with state rankings and population health indicators provide the basis for data-driven decision making in Garrett County. All of our objectives with the exception of publishing the community health improvement plan in January of 2018 have either been met or exceeded, and most indicators are currently experiencing the initiation of economies of scale that should propel community efforts further. [Insert Objectives & Numbers] Results/Outcomes for mygarrettcounty.com far exceeded the objectives originally set by the health planning unit. Members by June 30, 2016 1,431 and has grown to 1,759 by Dec 1, 2017. Discussion Posts by June 30, 2016 is 788. User records by June 30, 2016 is 5,121, and has grown to 13,363 by Dec 1, 2017. By Dec 1, 2017 101 groups were created on mygarrettcounty.com 7 Multisectoral strategies have been developed in the groups section by December 1, 2017. 90 data collection points are utilized on mygarrettcounty.com to track progress of identified community strategies before December 1, 2017. The ability to quantify multisectoral collaboration has been achieved utilizing mygarrettcounty.com. A representative Community Health Improvement Plan will be written by Jan 1, 2018, the health planning unit is on track to complete this objective on time. Primary data sources for this project include the open source framework the Garrett County Planning Tool is based on (Universal Community Planning Tool; GPLv3), Facebook and Twitter Insights, Google Analytics, PatTrac, Empower, and several other proprietary data systems. Data from these sources are reported on a continuous or monthly basis (dependent upon agency ability) to the Garrett County Planning Tool by either mechanical or automated means whenever possible (i.e.; analytics). Secondary data sources utilized in conjunction with this community process include the Maryland SHIP indicators, RWJF County Health Rankings and Roadmaps, Census data, and numerous other open/public datasets. Performance measures for this project are set and modified through the process itself. Each component of this project and those programs being tracked have objective measures in place, such as population penetration and engagement rates, service utilization, and several blossoming measures based sociodemographic indicators related to the social determinants of health. For a full reference of the measures set through this process, please visit the action groups on mygarrettcounty.com/groups, there any guest of the planning tool can view a chart with data per month on the following in addition to a data visualization. MyGC # of Sessions in January was 1,620 and as of December 1, 2017 is 2,439. MyGC # of Planning Partners in January was 286 and as of December 1, 2017 is 1759. MyGC # of Actively Engaged in January was 723 and as of December 1, 2017 is 1583. MyGC # of Page Views in January was 7160 and as of December 1, 2017 is 9789. MyGC Average Session Duration (Seconds) in January was 348 and as of December 1, 2017 is 312. Since the Garrett County Planning Tool is both an installation and a process, the results of programs and the deployment alike are analyzed to determine the omega effect of the economies of scale developed through uniform and collaborative reporting initiatives. In both cases, data was generated that would otherwise be unavailable to all of the stakeholders involved in the process. Additionally, several insights, such as those experienced in the model group for the Garrett County Digital Resource Guide, have provided data that can directly influence the trajectory of those programs and assist in delivering a higher level and more comprehensive continuum of care. Multiple modifications were made through the process of deploying, marketing, and training end-level users on the Garrett County Planning Tool. Many methods of modification in particular, were focused on implementing evidenced-based practices of A/B testing and allowing multiple stakeholder segments to experience a variety of end-level user experiences before resting upon the final model that is now present on mygarrettcounty.com. This concept, devised through a continuous refinement cycle has been very well received by our community and now integrates seamlessly with popular social media experiences to encourage participation and glean additional user insights from cross-domain analytics.
Developing sustainable systems should be of the utmost priority for public health innovations. Thankfully, due to technology and the decreased need for human capital in semi-automated systems, the Garrett County Planning Tool can continue to operate in perpetuity with relatively minimal overhead – two staff members. While most work is coordinated by the Population Health Unit, only a small portion of technical maintenance time is required to update SPAM definitions and ensure security patches are installed in a timely manner, with our specific case support coming from one of the two Population Health Unit members. Any additional technological support is purely for the adaptation or expansion of the tool. Additionally, the collaborative, multisectoral approach taken by the Garrett County Planning Tool diffuses systems maintenance responsibilities as additional community agencies recognize the immense value and literal capital value of the tool. The Garrett County Planning Tool has been a tremendously successful collaboration case study for our community as it has reinforced existing relationships, fostered new and emerging opportunities, and developed transparent and self-documenting processes to record how our community collaborates to make effective change both within public health and the social determinants of health. Several cost-benefit analyses were completed throughout this process for a variety of purposes. First, a cost-benefit analysis was initiated to determine the cost of developing an open source system versus deploying a market alternative. Unfortunately, for a rural, Appalachian community, the alternatives were far too limiting for the scope needed within this project, and exponentially expensive for a community working tirelessly to support existing programs and infrastructure. This analysis became the landmark case for developing and releasing work as available open source modules that any community could adopt and replicate without sustaining exorbitant costs. Several other analyses were also conducted for individual components and expansions, primarily in the fields of engagement development and onboarding community members. Stakeholder commitment is the underlying glue that binds the entire process of deploying and effectively utilizing the Garrett County Planning Tool in practice. Local stakeholders have taken an affectionate stance to incorporating the Garrett County Planning Tool into their work, and such efforts were a primary contributing factors to the recent distinction of Garrett County being named the first Culture of Health community in the state of Maryland. Sustainability plans for the Garrett County Planning Tool are as follows: 1. Collaborate with PHNCI (Public Health National Centers for Innovation), a division of PHAB and the Robert Wood Johnson Foundation to support the open source release of modules and an accompanying framework for replicating this tool in community across the globe through October 2018. 2. Work with a select pilot in conjunction with PHNCI (Public Health National Centers for Innovation), a division of PHAB and the Robert Wood Johnson Foundation to launch a statewide and multicounty pilot in a nonhomogeneous locale. 3. Develop and release additional programs, additions, and expansions through grant and local funding opportunities in collaboration with a variety of multisectoral programs to support ongoing maintenance and development costs.
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