Healthy Mendocino and the Community Health Improvement Process

Healthy Mendocino and its many community partners have been engaged in a Community Health Improvement Plan (CHIP) process since 2016. In June of 2016, more than 100 community members from all over Mendocino County convened in Ukiah to review the results of the Community Health Needs Assessment (CHNA) and to identify the top priorities for improving health and well-being in Mendocino County. Five Priority Areas were identified during this meeting and adopted to be implemented by Healthy Mendocino through a CHIP Project. Inland and North Coast Action Teams were formed around the priority areas of Childhood Obesity & Family Wellness, Childhood Trauma, Housing, Mental Health and Poverty.

Since that time, the Action Teams have been meeting monthly, creating visions for our future community, brainstorming strategies, strengthening collaborative relationships, trying new programs and creating policy recommendations for effective change. It has been a dynamic sharing and learning process.

As we bring this cycle to a close, we wanted to give a quick overview of the CHIP process and what we have learned. For a more in-depth analysis of each team, please look for our Final CHIP report due out December 31.

What is a Community Health Improvement Plan and Why is it Important?

The CHNA/CHIP process originated in the healthcare sector to meet the Internal Revenue Service requirement to track and report community benefit based on an assessment of community health needs. Tax-exempt healthcare facilities must have a process to assess community health needs and a written plan for how they will address these needs. 

Accredited public health departments also have public reporting requirements. They must participate in or lead a collaborative that conducts a comprehensive community health needs assessment that: 

• Describes the health of the population 
• Identifies factors contributing to the outcomes seen 
• Identifies community assets and resources that can be mobilized to improve population health 

There are many ways to address these requirements. While a CHIP process is required for regulatory purposes, it is not the only reason a community should undertake the process. A Community Health Improvement Process and Plan at its best is about engaging and mobilizing a community to think about, talk about, and act on the issues that will improve the health and vibrancy of the community. It is an opportunity to engage with the systems, policies and organizations that most directly impact health, wellbeing and community cohesion.

Communities around the country are engaging in ever deepening community processes to try and address complex health and social issues. A large body of research shows that only 20% of health is created by clinical care, the rest relating to health behaviors, physical environment, social and economic factors. While this has been part of the Public Health arena for years, the idea can be new for many community members and opens the range of possibilities for action to create individual and community health. For example, instead of developing a screening for diabetes risk identification, a community may instead choose to spend money on building a new neighborhood walking trail to help residents have access to more exercise opportunities. Whatever we choose, it takes conversations and relationship building to understand what our assets are and how we can most effectively build on them to improve community health. The process can be slow, messy and even frustrating at times, but with patience, persistence and strategy we can build a multi-pronged approach that will improve our current work while setting the stage to move toward long-term community change.

Community Health Improvement Mendocino Style

In the past, the Mendocino County CHIP process was led by county departments and have worked on very targeted programmatic areas and outcomes. For the 2016 cycle of Community Health Improvement, Healthy Mendocino was tasked with leveraging our existing collaboration to support broader community participation in the CHIP process that worked in the five broad priority areas. This was done with the commitment, time and energy of our many community partners, organizations dedicated to improving the lives of our community and community members themselves.

Complex social issues such as Poverty or Mental Health are notoriously difficult to address. Factors happen on many different scales, from national policy/legislation to individual behaviors. It can be confusing to understand how to prioritize action to create change. Ultimately though, individual actions, organizational priorities and state and national policy must be aligned to create change in these areas. Healthy Mendocino Action Team partners spent time working at multiple levels to test smaller interventions while examining countywide capacity and identifying key recommendations for policy changes.

As a longtime community member, I have been blessed to work with these teams and to meet so many sincere, dedicated colleagues who work overtime to try and make our lives and communities better. Each day, I learn about organizations that create new and innovative programs, generate resources and/or support people to build health and wellness: from Northern Circle Indian Housing (NCIH) that creates housing for five of our nine Native American Nations in Mendocino County and has been thinking a lot about the communities they work in and how the way they create housing can support stronger communities; or the Family Resource Center in Laytonville that provides everything from assistance with Health insurance and food stamps (CalFresh) applications, to teen peer counseling groups-- they are a hub for community building and gathering; or Project Sanctuary who provides advocacy and support for victims of domestic abuse, a robust prevention program and in the past year collaborated with community groups to host a tenants rights educational presentation for the North Coast community and opened their new teen center in Fort Bragg.

These community partners work hard, and like most of our community organizations, they often have more on their plate than their staffing, time and money will allow. They are creative and resourceful; in that Mendocino County way I have come to think of as GRIT. The Action Team members that attend the monthly meetings take time out of their busy schedules to think about big picture policies or coordinating strategies with other organizations, an activity that they find difficult to squeeze into their everyday work schedules. They find great benefit in the exchange of information with other organizations and collective thinking about how they can work together as a community of individual organizations to set priorities to achieve a common goal. In each of the teams, we looked at national and international efforts to improve these complex social problems and used those models to think about what changes might be needed in our communities to be more effective. The teams created recommendations, including how they would want to change the work of the team moving forward.

Moving Forward

One of the key messages that was repeated in each team, was that whatever strategy or action was taken through the Healthy Mendocino collaboration it had to support their existing work, not add on new work, and that the priority areas as they had been defined for this cycle were too broad, too complex and that we could be more effective if we focused our efforts.

So Healthy Mendocino listened and has restructured our organization and our efforts. As this first cycle of the 2016 collaborative Community Health Improvement Project led by Healthy Mendocino ends, I have been reflecting on all the work the teams accomplished. Some of it was programmatic, the type of “to do” list items we are all familiar with as action. Like the Community Marketplace Entrepreneurial Incubator Program, the Ukiah Kids Triathlon, or the Community Resilience Leadership Initiative Workshop series. Other pieces are equally critical but are more foundational work for next steps including community asset mapping and policy recommendations. I am grateful to the people of our community that continue to do amazing work and the time they spent engaging with Healthy Mendocino Action Teams. Thank you for your time and efforts. To view the agencies and organizations who have been involved in this community wide effort, click HERE.

Moving forward, we will take that foundational work they have completed, and we will build on it in a new cycle for the 2019 CHNA and CHIP implementation process. In some areas, we will hand off our recommendations and asset mapping to both our community partners and to the community at large to run with. The North Coast Housing Action Team for example has a core group of dedicated, fierce individuals that will continue their good work in community education with workshops (such as their ADU how-to workshops) and communication to help educate the public. Healthy Mendocino has shared with them the list of all the priority topics identified in Action Team meetings inland and on the coast, as well as our goals and strategies from our Housing initiative, many of which were identified by them.

To focus our future efforts, the Healthy Mendocino staff used all the information gathered through the Action Teams and over 25 listening tours throughout the county to develop three new initiatives to present to the new Advisory Council. A decision was made on November 4^th, to choose the initiative that will focus our next phase of action. To learn more about that process and the chosen initiative, look for our article on What's New for Healthy Mendocino: New Structure and Process.

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Julie Fetherston, M.S. is the Inland Coordinator for Healthy Mendocino. Julie facilitates opportunities for individuals, organizations to engage in creating new communities through information, communication and connection. Her academic background is in Psychology and Ecology which informs her wholistic perspective. She has twenty years of experience in strategic analysis and program development.