HomeMy WebLinkAbout2-27-12 Health Dept PresentationDeschutes County Board of Commissioners
I Work Session Agenda -February 27, 2012
Department: Health Services
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A. Overview -Scott Johnson, Director
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B. Tobacco Policy -Jock Pribnow MD PHAB vice chair, Tom Kuhn, David Visiko
1. Overview
2. Letter from PHAB and Rich Fawcett MD, Health Officer
3. Other public input: Bend Parks, St. Charles Health System, Telecare, Susan Ross
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f ~ 4. Discussion -Board guidance
I C. Downtown Health Center -Tom Kuhn, Kathy Christensen
1. Overview
'i 2. Discussion -Board guidance 1
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D. Strategic Plan draft -Scott
1. Overview
I 2. Discussion -Board guidance
I E. Health reform -Scott
1. SB 1580 passage -CCOs to form1 2. Dissolution of ABHA -Board guidance
.1 a. Proposed dissolution motion draft (handout) -Mark Pilliod
I b. Proposed financial plan draft (handout) -David Givans i
i 3. Health Board operation
a. Retain health authority roles at County level
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b. Manage resources regionally if more effective and efficiency
c. Tools: consent agenda; annual meeting; can call for regional meeting if concern
d. Formal policy guidance will be brought to you later
Thank you!
Deschutes County
Tobacco-free Policy Talking Points
February 2012
Tobacco-free policies are important for the health of Deschutes County residents:
• Tobacco is highly addictive, including smokeless tobacco, and carries serious
health risks.
• Tobacco-free policies offer more comprehensive protection (than smokefree
policies) for people and property.
o They reduce maintenance needs and costs. Less money is spent to clean
up cigarette butts and chew spit on sidewalks and other surfaces.
• Tobacco-free policies encourage smokers and smokeless tobacco users to quit.
o In Oregon, nearly 69% of smokers want to quit1 but struggle to do so. A
tobacco-free environment helps remove the temptation and supports
people kicking the habit.
o Sixty-one percent of smokers in Deschutes County attempted to quit for
at least one day {highest prevalence in the state; statewide average is
48.3 percent).2
• Tobacco-free policies increase productivity, as employees take less sick time and
smoking breaks.
• Tobacco-free policies ensure equal access to all. Secondhand smoke is an
access barrier for people with asthma and other chronic conditions.
• Tobacco-free policies help show kids that tobacco is not part of a healthy life.
o The Centers for Disease Control recommends tobacco-free policies as a
comprehensive youth tobacco prevention tool.3
In 2009, tobacco cost Deschutes county $80 million in lost productivity and
medical expenses4
Direct costs due to media expenditures (2009): $41.9 million
• Indirect costs due to lost productivity (2009): 38.1 million
• Total economic costs (2009): $80.0 million
• Source of data: Smoking-Attributable Mortality, Morbidity, and Economic Costs
(SAMMEC). http://apps.nccd.cdc.gov/sammeC/index.asp. The statewide
productivity losses were recomputed using 2009 smoking prevalence numbers,
overall mortality rates for 2004-2007 for tobacco-related cancers, and current
population data. The smoking-attributable expenditures are expressed in 2009
dollars.5
1 Oregon Tobacco Facts, 2011, page 17.
2 Oregon Tobacco Facts, 2011, page 18.
3 http://wNw.cdc.govltobacco/data_statisticslfad_sheetsisecondhand_smokeiprotectionlreduce_smokinglindex.htm
4 Oregon Tobacco Facts. 2011, page 6.
5 bttR:!JQYb!i.Q.J)!taltb~.Q[~QfI"gQYlPJ~yen.tLQ.I)W~Un~~Qtta.c.g)PI~~ntiQfI!.Dc:x;ym~n~.1<:;QY£!M1i.Qt~~nQt~.Rgf
Our community wants tobacco-free policies and they recognize the dangers of
secondhand smoke:
[71%] of people surveyed said it is very important and [13%] said it was somewhat
important to them that Deschutes County established tobacco-free buildings and
grounds.
• [51%) of people surveyed said they were bothered either a little or a lot by
tobacco smoke while visiting a Deschutes County building.
• [86%) of people surveyed try to avoid secondhand smoke when out and about.
• [68%) or people surveyed believe breathing secondhand smoke is very harmful
to one's health and [23%) believe it is somewhat harmful to one's health.
Enforcement
• Tobacco free policies are easier to enforce than those with designated smoking
areas, demanding less staff time for enforcement.
• 100 percent tobacco-free policies are easier to enforce because there are no
gray areas, and such policies reduce costs associated with cigarette litter and
tobacco damage to facilities.
• Tobacco-free poliCies work best when compliance is viewed as the shared
responsibility and the right of all in the community-smokers and nonsmokers
alike. Concerns can be mitigated by emphasizing the goal of ensuring a safe and
accessible space for all, and by encouraging open discussion and airing of any
questions.
• Clearly communicate the tobacco-free policy by developing an internal and
external communication plan to ensure everyone understands what the policy
entails and the proper steps for enforcement. This will need to be mapped out
after a more detailed planning session with the decision makers. Deschutes
County Tobacco Control can offer to help in that process and also help develop
the internal and external communication plan).
o Sample language:
• While X is ultimately responsible for enforcing the new policy, we
encourage everyone to politely ask others to refrain from using
tobacco while on X property.
• For those who absolutely have to smoke, we ask that you step off
of the property to do so. Please be courteous of neighbors and
area businesses by keeping the noise volume down and picking
up your cigarette litter.
Bark dust fires:
• During 2005-2009 there were almost 6,400 cigarette fires in Oregon, which were
responsible for 34 deaths, 133 injuries, and an estimated $20 million in property
loss. 6
Trend in businesseslworksites going Tobacco free
6 http://www.oregon.gov/OSP/SFM/docslData_ServicesJReportsl2005
2009_0regon_Cigarette_Fires_in_Single-And_Multi-Family-Housing.pdf?ga=t
Business, organizations and institutions across Oregon are implementing smokefree and
tobacco-free policies, including:
o Housing Authorities
o Hospitals
o City and county campuses
o College campuses
o Parks, Farmers Markets and other outdoor spaces
o Events, such as fairs and powwows
o Hotels
Emissions of cars versus secondhand smoke
• Cigarette smoke has a higher concentration of carbon monoxide than exhaust
from a clean, well-maintained vehicle. 7
Oregon Quit Line
• The Oregon Tobacco Quit Line is available to anyone, regardless of income or
insurance overage. Call 1-800-QUIT -NOW or 1-877 -2NO-FUME for Spanish, or
visit www.oregonguitlin~
• The Oregon Tobacco Quit Line also offers an online, live chat coaching service
for those who would prefer to receive help to quit via their computer.
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7 http://faculty.washington.eduJdjaffe/ce3.pdf
Deschutes County Public Health Advisory Board
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February 27, 2012
Public Health Advisory Board
2577 NE Courtney Drive
Bend, Oregon 97701
February 27, 2012
Deschutes County Board of Commissioners
Anthony DeBone, Chairperson
Alan Unger, Vice Chairperson
Tammy Baney, Commissioner
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I Re: Support of 100% Tobacco Free County Properties
Dear Board of Commissioners:
1 The Deschutes County Public Health Advisory Board (PHAB) would like to request that you take the lead in
protecting the health of Deschutes County residents. Specifically, expand the current restriction on the use of
tobacco products to include the entire campus of all Deschutes County properties. PHAB asks for your formal
support to better protect the health of clients, visitors and employees who frequent our properties. With this
request, PHAB is aligning with the Triple Aim framework; by improving the health of our population, and
reducing or, at minimum, controlling the costs of care, major benefits will be realized by our viSitors, our
county residents, and our employees.
With your leadership, we could remove second-hand smoke and other tobacco in and around our public
spaces. This would reduce health safety risks for all who access our campus and ensure equal access to the
facilities for those who are medically sensitive to the effects of tobacco smoke, such as people with asthma
and pregnant women. This would achieve an exponential effect: motivating current smokers to quit smoking
and safeguarding visitors, clients and staff-86 percent of whom are nonsmokers-from the toxic effects of
secondhand smoke. It is our understanding that county dollars would be saved, by a reduction in county staff
time utilized in cleaning up litter created by cigarettes and putting out landscaping bark fires.
Research further shows that any exposure to secondhand smoke, even outdoors, has harmful biological
consequences. Further, removing all smoking cues facilitates quitting, and research demonstrates that 70
percent of smokers wish to quit.
Tobacco is the leading cause of preventable death in the world today and in Central Oregon. Smoking-related
deaths from cancer, heart and lung diseases, and other conditions account for more than 440,000 premature
deaths each year, about one in five deaths in the United States. Let's make Deschutes County a key
stakeholder in the statewide tobacco free movement by being proactive in our policies.
Sincerely,
Public Health Advisory Board DCHS Health Officer
Kim Curley Reynolds, Chair Dr. Richard Fawcett
Deschutes County Board of Commissioners
Anthony DeBone, Chairperson
Alan Unger, Vice Chairperson
Tammy Baney, Commissioner
Re: Support for 100% Tobacco Free County Properties
Dear Board of Commissioners:
With mounting evidence of the consequences of tobacco use including negative health, social, economic and
environmental effects, Deschutes County's Well ness Task Force respectfully requests that you support a
comprehensive worksite policy designating all County Facilities as 100% tobacco free.
Currently, Deschutes County policy states that every County facility shall prohibit tobacco use within thirty
feet of all doors in each building. State law mandates that Deschutes County Health Services be a completely
tobacco~free campus. In addition, the Fairgrounds, Community Development Department and the Mike Maier
Building, have all voluntarily adopted tobacco free buildings and grounds.
Tobacco free policies are not just designed to protect employees, clients, and visitors from the negative health
effects of secondhand smoke. They are also intended to improve the overall work environment and support
tobacco users who are interested in quitting. Examples include provision of tobacco cessation resources,
promoting a cleaner worksite environment, containing health care costs, and establishing a positive
organizational image.
A January, 2012 public opinion survey indicated that 84% of over 800 respondents believed that it was
'Very/Somewhat Important' for Deschutes County to establish tobacco-free buildings and grounds. County
employees mirrored these findings in an October, 2008 survey that asked, "In your opinion, how important
is it for Deschutes County to establish tobacco free grounds?" Over 87% answered 'Very/Somewhat
Important'.
The trend toward tobacco~free environments continues to grow. St. Charles Medical Centers, Mosaic Medical
Clinic, Bend Park and Recreation District, the City of Bend, and all State-owned buildings now have tobacco
free grounds. As county government officials, it is important to set an example for the community and send a
clear message that Deschutes County is committed to the health and safety of all residents.
Thank you for your consideration.
'Deschutes County VVeCCness Task Jorce
A team of representatives from every County Department
2/27/2012
CHANGE IS IN THE AIR:
TOBACCO FREE WORKSITES
David Visiko M.S.
Tobacco Prevention &Control Coordinator
Deschutes County Health Services
Deschutes County History
• Smoking prohibited 30 feet of any county building
entrance or facility.
• Smoking and tobacco use is not allowed in any County
building, facility or automobile
• October, 2009: OAR requires addiction outpatient
programs to be 100% tobacco free facilities and grounds .
• Health Services Campus, Courthouse Annex, Downtown Health
Center, and Wall Street Services Building affected .
• Community Development Building and Mike Maier County Services
Building (proximity to child care center and health services).
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2/27/2012
Factors that Affect Health
Som:e: Dr. TOO1a'l R Frieden, Director, u.s. Centers fOC DiseaseCoo1rol & Prevention
Oregon vs. rest of United States, FY 1993 ·2010
100
90
80
tII)
70
is 60
! s 50
'15B40
Gi a.. 30
20
10
o
-OR -rest of US
In 1996, Oregonians
pass Measure 44,
raising the tobacco tax
and funding the
Tobacco Prevention ~-----;======-=====::::;----t----and Education Program I
~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~
Orzacllow.kI and walker (201 The Tax Burden on Tobacco.
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Tobacco is the Leading Preventable
Cause of Death in the U.S.
500,000
400,000
'300,000
200,000
100,000
o
T obaeeo Diet & InaeUvity ou..r Caus..
Related
• AIDS
o Ak:ohol
• Firearms
• Illegal Drug Use
• Motor Vehiel.
DI Poor DletlPhysleal
InaeUvity
o Passive Smoking
• AcUv. Smoking
JAMA, March 10, 2004 Vol 291, No,10
Tobacco 's toll on Deschutes County
in One Year
• 14% of adults regularly smoke
· 4,471 people suffer from a serious tobacco related illness
• 22% of all deaths in Deschutes County
• $42 million is spent on medical care
• $38 million in productivity lost
2/27/2012
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2/27/2012
Cost Impact of Tobacco Use
$5,600 per smoker per year when you factor in:
-Greater health care costs
-Increased absenteeism
-Work time spent on smoking rituals
-Higher life insurance premiums
-Greater risk of occupational injury
·Costlier disability
-More disciplinary action
860/0 of Deschutes County Adults
Currently Do Not Use Tobacco
133,924 Adults in Deschutes County
j.<;{S --I <D /l
18,883 115 ,041
14% 86%
70% of Deschutes County tobacco users want to quit
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2/27/2012
Positive Impacts of Proposed Policy
Can positively impact 95% of our adult population
• Can positively impact Deschutes County residents who do
not smoke by reducing, their exposure to secondhand
smoke and eliminating smoking triggers.
AND
• Can assist tobacco users who want to quit, reducing
chronic disease and its impact on health care costs.
Adult Quit Patterns
Deschutes County smokers have the
greatest desire to quit smok'ing in the state .
• 47% of Oregonians stopped smoking for a day or longer
in the past year in an attempt to quit
·61% of smokers in Deschutes County attempted to
quit for at least one day (high.st prevalence in the
state;).a..gonTObKCOF_.2011._1a.
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2/27/2012 "
Deschutes County survey shows support
for tobacco-free policy
More than 800 people completed a survey fielded by
Deschutes County Health Services to determine the level
of support for establishing a 100% tobacco-free policy at
some or all of Deschutes County properties.
84% of survey respondents were in favor of 100% tobacco
free county properties.
Public Opinion Survey Results Feb.2012
Respondents' views on importance of establishing tobacco·free
buildings and grounds in Deschutes County
• Very important
• Somewhat important
• Not very important
• Not important at all
N=803
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" 2/27/2012
Survey Results at a Glance:
•91 % visit Deschutes County Offices
•86% try to avoid Second Hand Smoke
• 91 010 think Second Hand Smoke is harmful
•84% think tobacco free buildings important
804 survey respondents
Where do we go from here?
• If supported, next •Recommendation steps:
to go 1000/0
tobacco free • Obtain management
support
• Establish policy
implementation committee
• Information &Input
Sessions with staff
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2/27/2012
Compliance of Proposed Policy
Internal and External Communication Plan.
o Clearly communicate the policy to staff and public
Compliance with this policy is the shared responsibility of
all Deschutes County personnel.
• Any person who observes a violation of the policy is authorized and
encouraged to communicate the policy with courtesy and respect.
Management and supervisory staff are responsible for
ongoing compliance with this policy within their respected
work areas .
• Management and staff are expected to adhere to standard practice
in resolving any issues of noncompliance with employees.
8
,
Downtown Health
Center Closure
February 2']th, 2012
Kathleen Christensen
Clinical Supervisor
1
M.I.R.S.
DTHC Opened March 2006
o Served teen and young adults up to age 25
o Housed the MARS program
o Partially staffed by AmeriCorps volunteers
DTHC Visits Declining
2011-6,348 RH Visits / 9,728 Total Visits
" Main Dffice-3492 RH visits /6141 total visits l'
Redmond Dffice-1911 RH visits /2478 total visits l'
I LaPine Dffice-263 RH visits -309 total visits l'
Downtown Health Center-682 RH visits -801 total visits ~
o 2010 -6,375 RH Visits / 8722 Total Visits
Main Dffice-3352 RH visits /5122 total visits
Redmond Dffice-1832 RH visits /2218 total visits
LaPine Dffice-240 RH visits /308 total visits
Downtown Health Center-951 RH visits -1073 total visits
2
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DTHC Statistics
o Age of clients
n 15 and under 14%
" 18-24-64%
( 25 and over 22%
o 79% Females, 21% male
o Lower Clinic Productivity at the DTHC
.~ Bend and Redmond RN Schedules are at 85%, DTHC is at 50%
(~ Bend and Redmond NP Schedules are at 100%, DTHC is at 80%
o Averaged 5 clients/day in 2011
o Not efficient use of staff time.
Ratio of support staff to clinician is 1:1.
Large amount of maintenance time for a two day a week clinic.
o Not serving the teen population very well-14% of clients 17 and
under.
o Staffed by an RN 1 day a week.
Decreased scope of practice compared to NP.
Decreased revenue from billing if client has insurance.
o More clients are coming in for srD services than Family Planning
services.
Access for Family Planning services are available at PPH on the west side
of town .
3
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o If implemented, Staff will be reassigned.
Main office currently open Mon -Fri 8-5 .
o Will be open until 6pm two days/wk and 7pm 3 days/wk.
, Open at lunch hour 5 days a week.
o Have reviewed this plan with staff and advisory board.
o Will residents be underserved?
v Results from client survey.
o Where can they get services?
Next Steps -News Release, Setting Closure Date
To assure clients are aware we will have sign age, forward phones, and have
health educators create new promotional materials.
4
Deschutes County Health Services
2012-15 Strategic Plan draft
Deschutes COUnty Board of Commissioners
Work SessIon February 27 2012
Accomplishments: a look back Page 26
• More service for more OHP members
• More contracted agencies
• Integration with Mosaic Medical (3)
• More school -based centers (6)
• County health ran kings positive ##7
• My Future My Cho ice ; Cuidate
• First Or. LAUNCH program 5-yr grant
• Regional Nurse Family Partnership
• Health Council-Health Board
• First State demonstration site for
integration
• Significantly more residential options
• less hospitalizations thru ACT,
Wraparound, AMHI, EASA
• 2009 Health Report and update; key
role in health assessment
• Fi rst beta site in nation for Public
Health accreditation
• 2009 : State BH certifications
2010 : State PH triennial review
2/27/2012
1
a. Table of Contents same as regional Health Improvement Plan
b. Mission -Vision -Values -SWOT analysis
c. Regional Health Report & health assessment data
d. Meaningful DCHS staff involvement
e. Advisory Board work sessions & reviews
f . SOC work session February 27, 20U, feedback
g. R Fawcett MD, Health Officer M Williams, MD sign off
h. Advisory Boards adoption March 21, 2012
i. Board of CommiSSIoners adoption April 2012
j. Regional Health Improvement Plan (CO Health Council)
k upda am fa
Plan Construction Page 21
Environmental Scan
Opportunities
1. Our County staff 230+
2. We value collaboration
3. Progressive, we want to improve
4. Better care thru integration
S. A focus on best practice
6. State health reform
7. Change as opportunity
Page 7
Challenges
1. Need is greater than resources
2. The economy
3. Complex regulatory environment
4. State agencies as silos
S. Measuring results
6. Can we streamline
7. Change as risk and ambiguity
2/27/2012
2
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2/27/2012
Highlights: 9 sections, 66 goals
A. Ingease Access (Page 9 ): meet OHP a"!'§'i standard. open Redmond
Service Center, South County future, school-based health centers
B. Imoroye Health (Page 10): Living Well expansion, prevent childhood
obesity, improve maternal mental health
C. Improve care (Page 11): electronic health record systems, quality councils ,
Early learning Council work, public safety preparedness (several areas)
D. Reduce Costs (Page 12) : less hosojtalizations-Assertive Community Tx.
(ACT), children's wraparound, Early Assessment & Support Alliance (EASA)
E. Ingease Int"ration &Collaboration (Page 13): Primary care and
behavioral health (at least 10 locations, PH internship program with OSU
Highlights continued
F. Pursue Excellence (Page 15 ): National Public Health Acaecfrtation;
Environmental Health to meet national FDA standards; behavioral health
outcomes tool across all providers
G. Expand Regional Efforts (Page 15 ): Central Oregon Health Board; Health
Information Exchange; regional Nurse Family Partnership
H. Strengthen Our Orpnization (Page 16): Staff development actions;
behavioral health emergency preparedness
I. Promote Sound Health Policy (Page 17): 13 policy directions including the
Triple Aim, Regional Development; Recovery &Resiliency; countv-operated
behavioral health services, integration, tobacco policy etc.
Bdarri sugge lions and diTf!Clion on Ih Plan are welcomed
3
Deschutes County Health Services
Strategic Plan 2012-2015
Final Draft February 2012
. , . .... . . . ~. '"--., . '.
~ • t
Summary
This Strategic Plan outlines a vision and set of goals to improve the health of our residents,
strengthen our organization and promote community collaboration. It is a plan for action
that capitalizes on national, state and regional reform. It is both ambitious and a realistic
portrayal of our focus and capability over the next four years. It is rooted firmly in goals that
will lead to better community health, better care and work that will promote health and
lessen society's burden for unnecessary human and financial costs .
This new plan carries forward a commitment of Deschutes County Health Services to use
public health assessment practices and community guidance to frame a clear agenda,
mobilize our resources and act. Through this effort, we will continue to ensure County
government is accountable and helpful to our Countys residents and that we fulfill our
mission to promote and protect the health and safety of our community.
In the past five years, we've acted on past plans, sponsored many new projects, expanded
our services and improved access to care. A sampling of those accomplishments is listed in
Appendix iii. In 2009, our Department was formed as a consolidation of the County's Health
and Mental Health Departments with Environmental Health added in 2010.
In 2012, we will help thousands of residents, offering health and human services at more
than 40 locations including schools, clinics, agencies and a variety of outreach efforts. We
will also continue to increase our investment in our economy and the workers at many local
helping agencies.
While we are optimistic and excited by the promise of health reform, a difficult road lies
ahead. All signs point to reductions in public funds and rising costs as well as a need to push
forward with difficult changes in the way we work and the way people are served. Each fall,
with the help of our community boards and the Central Oregon Health Board and Health
Council, we will review our progress, reassess health reform and our community and
regional needs and update our priorities to remain current and relevant to the work at
hand. With this in mind, we look forward to a healthier Central Oregon in the years ahead.
We hope you will take the time to review the 67 goals in this document, to ask difficult
questions and to join us in this effort. With adoption of the plan we will move forward
immediately on a number of these actions. We do this with gratitude for the work of a
talented and dedicated staff, the thoughtful guidance of our community boards and
volunteers, the help of community partners and the commitment of our Board of County
Commissioners to community health and well-being.
In partnership with our community and region
Scott Johnson, Director
Deschutes County Health Services
Deschutes County Health Services Strategic Plan
Page 2 of 32
2.24.2012
Endorsements and Adoption
Adopted this _day of March, 2012, by the Deschutes County Public Health Advisory Board.
Kim Curley-Reynolds, Chair
Deschutes County Public Health Advisory Board
Adopted this __day of March, 2012, by the Deschutes County Behavioral Health Advisory Board.
Darrel Wilson, Chair
Deschutes County Behavioral Health Advisory Board
Adopted this _day of March, 2012, by the Deschutes County Health Officer and Medical Director.
Dr. Richard Fawcett, Health Officer Dr. Marc Williams, Medical Director
Adopted this _day of , 2012, by the Deschutes County Board of Commissioners.
Anthony DeBone, Chair
Alan Unger, Vice Chair
Tammy Baney, Commissioner
ATrEST:
Recording Secretary
Deschutes County Health Services Strategic Plan
Page 3 of 32
2.24.2012
Table of Contents
I. The Triple Aim Page 5
II. Our Mission, Vision and Values Page 6
III. SWOT Analysis Page 7
IV. Strategic Plan Domains
A. Increase Access Page 9
B. Improve Health Page 10
c. Improve Care Page 11
D. Reduce Cost and Increase Cost Effectiveness Page 13
E. Increase Health Integration and Collaboration Page 13
F. Pursue Excellence Page 15
G. Expand Regional Efforts Page 16
H. Strengthen Our Organization Page 16
I. Promote Sound Health Policy Page 17
Appendices
i. Membership the Strategic Planning Group Page 21
Accreditation Measure 5.3.1 A 1. a
ii. Strategic Planning Process
Accreditation Measure 5.3.1 ALb. Page 22
ii a. 2012-2015 Strategic Plan Timeline
ii b. Annual Strategic Planning Cycle
iii. Accomplishments in Recent Years Page 27
iv. Ten Likely Environmental Changes in 2012-2015 Page 29
v. Community Health Assessment for Public Health Accreditation Page 30
vi. Regional Health Improvement Plan: Ten Priority Areas Page 31
Deschutes County Health Services Strategic Plan
Page 4 of 32
2.24.2012
I. The Triple Aim*
Our Vision for a Healthy Central Oregon
BETTER HEALTH
Improve the health of people in
Deschutes County & Central
Oregon
BETTER CARE
Improve our service
quality, access, reliability,
safety and satisfaction
LESS COST
Contain per capita cost;
undertake preventive
care and hea lth education
*The "Triple Aim" is a health reform concept developed by the Institute for Healthcare
Improvement, an independent, nonprofit organization helping to lead the improvement of health
care throughout the world. Triple Aim thinking is intended to improve health and health care .
Triple Aim is now part of Oregon law and a founding concept for the Oregon Health Authority. It
has been adopted by the Central Oregon Health Council and Deschutes County Health Services.
Deschutes County Health Services Strategic Plan
Page 5 of 32
2.24 .2012
II. Our Mission, Vision and Values
Our Mission
To promote and protect the health and safety of our community.
Our Vision
Deschutes County residents experience excellent health and the highest quality of care.
Costs of health care gradually decline. We successfully advance public health policy, health
assessments and health solutions as well as affordable, accessible and coordinated services.
As an organization, we adapt effectively to health reform, focus on our strengths and areas
where we are most needed for the region's success. We offer a capable workforce and a
commitment to excellence. We succeed by joining with other counties, the health care
system, the business and nonprofit communities and a responsible citizenry.
Our Values
Advocacy The pursuit of community health, healthy lifestyles and access to health care.
Collaboration True partnership with our customers, community agencies and coalitions.
Cultural competence Awareness and responsiveness to the diversity in our community.
Excellence A commitment to best practice and high quality service to the public.
Innovation A willingness to try new approaches to better serve our community.
Professionalism The highest level of personal integrity, conduct and accountability.
Stewardship The wise, effective and efficient use of public resources.
Workplace health Work sites that promote respectful interactions and healthy lifestyles.
Deschutes County Health Services Strategic Plan
Page 6 of 32
2 .24.2012
III. SWOT Analysis
Strengths, Weaknesses, Opportunities, Threats ... Winter 2012
The development of this Strategic Plan has included an analysis of data on health needs and trends in our
County and region (see Appendix v: Health Assessment) as well as this assessment of our agency and the
conditions in our County, region and state. We have used this information to frame our long-range goals and
fulfill our mission to promote and protect the health and safety of our community.
summaryof en°tieal eonSl°d erations:
Our strengths:
l. Our workforce: talented, energetic, professional.
2. Our innovation and a commitment to improve.
3. Our partnerships and community providers.
Opportunities:
l. State, regional, local support of health reform.
2. Better care for our clients through integration .
3. Regional work with the Health Council & Board.
Challenges I weaknesses:
l. Complex regulatory requirements.
2. Management in a changing environment.
3. Measuring the impact of our work (outcomes).
Threats:
l. A down economy: impact on community, funding .
2. The impact of any opposition to health reform.
3. The impact of the social determinants of health.
Within our organization ...
Our Strengths:
Dedicated, passionate and highly professional staff; staff stability; a high value placed on teamwork and support
for one anothers' efforts; a progressive organization that values innovation in our programs and services;
promotion of creativity; use of evidence based practices and programs; willing to explore new opportunities, to
continually strive to expand our benefit to the community; we value community involvement and partnerships,
we benefit from the help of several community advisory boards; we prepare for change rather than react to it;
actively participate in many community partnerships; we work to shape our environment, our reputation with
the State of Oregon is very good, client-focused in a client-centered community; we manage limited resources
responsibly; open to looking at outcomes; Deschutes County and the County Commissioners are very supportive
of our work; diversified, providing wide range of valuable services; developing a greater commitment to quality
improvement throughout the organization; forward thinking, undertaking a number of strategic efforts that take
time to develop and grow; a long range financial approach, using our reserves wisely to limit program crises.
Our Weaknesses:
It is challenging to manage effectively in a changing environment; learning to adapt and adjust to new
opportunities while managing busy daily operations; our technology (electronic record system) needs an
upgrade, improvements are under way but are taking time and resources and will be difficult to implement; at
times, we have been resistant to change and to integrating our services and staff support although this is
Deschutes County Health Services StrategiC Plan 2.24 .2012
Page 7 of 32
changing on many levels; we need to become more adept at managing based on performance measures,
outcomes and the Triple Aim (better health, better care and less cost); unable to help everyone who needs
assistance, particularly the uninsured; many client issues are more complex than in the past, particularly with
health and economic issues for clients; administrative support services have not kept pace with our program
development; like similar agencies in Oregon, with all the Federal and State regulations and complexity, we
vulnerable to a State or Federal audits and are working hard to improve in this area; need to strengthen our
planning processes and health assessment capacity, using health, demographic and economic data; need
effective internal and external communication during a time of change; can be guilty of "silo thinking"; at times
it is difficult for staff to understand the big picture; need to improve our billing practices by strengthening our
Business Office, linking to clinical records; have lacked an agency-wide commitment to quality improvement;
need greater client voice and involvement in our work.
In our environment ...
Opportunities:
Oregon is well positioned for Federal and State health reform, especially with the new Oregon Health Authority
and recent Coordinated Care (HB 3650) and Health Exchange (SB 99) laws; innovation will be highly valued in the
next several years with Federal, State and regional health reform; the formation of the Central Oregon Health
Council (community-wide) and Health Board (counties) is well regarded so far; potential to increase County
involvement in community health; potential to increase focus on prevention and population health; County
Commission likely to place a high value on collaboration and community involvement; strengthening public
health work through national public health accreditation; potential success of LAUNCH (Linking Actions for
Unmet Needs in Children's Health) and early childhood health and education; prevention (especially in public
health) will be important to "bend the cost curve" in health care; State Health Improvement Plan calls for
strengthening public health infrastructure in Oregon; the number of insured Oregonians will increase
significantly in 2014, requiring a more robust workforce; federally qualified health clinics (e.g. Mosaic Medical,
La Pine Community Health Clinic) are likely to expand to meet an increasing need; new Behavioral Health
Organization (BHO) through the Central Oregon Health Board will help integrate mental health and addictions
and the work among our three counties; contracting OHP behavioral health through PacificSource helps
integrate with physical health, makes sharing health information easier as we seek better health for our clients
and community; improving quality assurance; ability to lessen bureaucratic requirements; peer services in
behavioral health; new community health worker concept.
Threats to our services and success:
Public resources are very limited; the Oregon economy is likely to remain difficult for several years and could
negatively impact funding and reform, increasing the need for our services but creating instability in the Oregon
budget; the State's budget shortfall is reSUlting in a loss of critical community services for vulnerable
populations, it will require reducing health costs $329 million in 2011-13, County contributions not likely to grow
significantly; State cuts will impact our clients and our ability to keep up with greater need for people with and
without insurance coverage; Department services and staffing levels; will our provider network be able to
shoulder a greater responsibility to serve people in need; increases in costs of our services exceeds our likely
revenue; at times, a consensus must be reached before we can make the changes that are necessary, that can
slow us down; Medicaid regulations are complicated and the focus on fraud and abuse is difficult and threatens
our resources and programs; for behavioral health, the capitated system requires service to everyone eligible
with a need; the recent Administrative Rules in behavioral health require work force education and change in
our processes; national and global environment and economy will impact the State of Oregon and our future.
2.24 .2012 Deschutes County Health Services Strategic Plan
Page 8 of 32
N. Strategic Plan Domains
Key:
co HIP: Goals aligned with the Central Oregon Health Improvement Plan
OR HIP: Goals aligned with the Oregon Health Authority Health Improvement Plan
Note: The Goals listed in this plan are not listed in priority order.
Items listed in red represent the final edits requested by our Advisory Boards
A. Increase Access
Definition: Improve access to health education, preventive services and health care. Provide timely care to
achieve the best possible health outcomes.
1. Cultural Competency: Reflect our community profile in hiring policies and service practices. Cultural
Competency will be accomplished through the following actions: a) Conduct a health assessment of the
ethnic and cultural profile(s) of Oregon Health Plan members and other service populations by October
2012. b) Reassess current program offerings and assure all programs are able to address the cultural needs
of Hispanic clients and other groups as warranted by February 2013. c) Reassess the composition of our
community boards. d) Quantify specific personnel needs in each program to assure a capacity to serve
clients needing help. e) In priority areas, assign additional weight to bilingual candidates, recruiting workers
or volunteers who are bilingual and bicultural by July 2013 or with next available opening(s). OR HIP
2. Dual Competencies: Develop behavioral health staff expertise in priority population areas. a) Staff
knowledgeable and skilled in behavioral health practice and service to people with developmental
disabilities. b) Staff knowledgeable and skilled in behavioral health practice and service to veterans who fall
into our priority population groups (as well as improved coordination with the veterans' service system).
c) Staff knowledgeable and skilled to serve clients with health issues related to both mental illness and
chemical dependency. d) Involvement of staff or partner agencies to address chronic disease issues and
general physica l health .
3. Translation Services: Assure that Health Services Spanish interpreters meet State of Oregon qualification
criteria for healthcare interpreters by January 2014. Qualification criteria will be tracked through the
Oregon Health Authority's Office of Multicultural Health and Services.
4. Hours of Operation: Offer additional hours of operation and services. Expand hours of operation to
evenings and Saturdays, piloted at the new Redmond Service Center by September 2012. a) Clarify potential
need for variable work hours at time of hire. b) Assure needed support staff for such operations.
5. Redmond Service Center: Open the Redmond Service Center as a comprehensive health and human service
center by January 2013 with tenants to include State of Oregon Department of Human Services, Deschutes
County Health Services and Mosaic Medical.
6. School Based Health Centers: Strengthen the school based health center system in Central Oregon.
a) Open Sisters School Based Health Center (new building) by July 2013. b) Complete Long Range Plan to
recommend the full complement of centers for a comprehensive County and regional system by July 2014 .
Deschutes County Health Services Strategic Plan 2.24.2012
Page 9 of 32
c) Complete a comparative business analysis of the best option(s) for system management and oversight by
July 2014. CO HIP -OR HIP
7. South County Healthcare: Work with provider groups to increase access to healthcare for La Pine and South
County residents. a) Participate in 2012 task force with providers who share the same vision for increased
access to primary, urgent care and behavioral Health services in South County. b) Assist in educational
campaigns to reduce the amount of ambulance transports and emergency room visits .
8. Reproductive Health: Assure quality, timely access to reproductive health services within our community as
we move toward health care reform. Access can be measured through collaborations formed, identifying
access and monitoring it. In 2010, an estimated 609 unwanted pregnancies were averted in Deschutes
County, saving the health care system $5 for every $1 spent.
9. Behavioral Health Access Standard: a) Meet OHP access to care contract requirements for members in need
of behavioral health services, reporting quarterly. b) Increase use of community behavioral health network
and outpatient services: Increase the percentage of unique OHP members served by panel providers by
100% by July 2013 . Measurement: baseline of 694 unique people served in FY 2011 . CO HIP
10. Access to Geriatric Behavioral Health Care and Consultation: Seek resources to expand the Health Services
Seniors Program as a resource to the health system, care facilities, families and seniors in need throughout
Central Oregon. CO HIP
B. Improve Health
Definition: In collaboration, seek to assure the health of County residents through processes, activities or the
services of our organization(s). Health outcomes include morbidity and mortality; physical, social and mental
well being; nutritional status and qua 'iity of life .
1. Living Well Program Expansion: Improve the health of adults with chronic conditions in the region through
expansion of the Living Well program. Program enrollment of 1,700 people, with 1,100 completing the
course, saves an estimated $2 million in health care costs. Increase enrollment in the program annually 25%
from a baseline of 242 clients in 2011; measured each July through 2015. OR HIP -CO HIP
2. Wellness Marketing Campaign: Develop and promote Worksite Wellness tool kits to regional organizations
in order to achieve adoption and implementation from 2012 through 2015. Toolkits would assist
organizations in developing well ness policies, promoting Commute Options, creating smoke-free campuses
and referring to Chronic Disease Self-Management. Success measured by the number of tool kits distributed
and implemented. The purpose of worksite wellness programs is to reduce the costs of health insurance
claims by improving employees' health and subsequently maximizing the return on investment. OR HIP
3. Partner Violence: Create a prevention plan to address intimate partner violence at the individual,
community, department and policy levels by 2015. The plan will be developed through convening an
intimate partner violence committee, developing the plan and advocating for the plan at the community
level. The Centers for Disease Control and Prevention has recently identified intimate partner violence as
widespread and a major public health problem in the United States. The term "intimate partner violence"
Deschutes County Health Services Strategic Plan 2.24.2012
Page 10 of 32
describes physical, sexual, or psychological harm by a current or former partner or spouse. Create a linkage
to Behavioral Health.
4. Childhood Obesity Prevention: Expand capacity and provide support to community activities that focus on
reducing childhood obesity. Needed research will be supported and best practices will be implemented in
Central Oregon. a) Participate with the Kids @ Heart Program in developing an action agenda by December
2012. b) Identify opportunities to engage with local and state partners, including hospital systems, school
based health centers and schools. Seek funding and/or other support as needed. CO HIP -OR HIP Create a
linkage to Behavioral Health .
5. Maternal Mental Health: Using the Substance Abuse & Mental Health Services Administration's model,
collaborate with community partners to develop a maternal mental health system which provides
prevention, screening and treatment for women at risk. a) Conduct a survey of behavioral health, medical
and community providers; identify gaps, and report to Public Health Advisory Board by July 2012.
b) Conduct maternal mental health trainings and grand rounds for physicians by September 2012.
c) Facilitate a community taskforce to develop integrated plan of care, funding sources, and method of
evaluation. d) Conduct on-going assessment of need through standardized community screening, reporting
and tracking by September 2015. CO HIP -OR HIP
C. Improve Care
Definition : Improve the care people experience and our associated practices and processes . Identify areas
for improvement, monitor compliance and manage risk. A premium is placed on connecting staff to the
performance of the organization.
l. Early Learning Council Development: As the public health and mental health authority and as a health
provider, participate in the Central Oregon Health Board's development of a regional Early Learning Council
system. Integrate public health and behavioral health services with this new Oregon child development
model. Measurement: Role definition and measures by July 2013. CO HIP Create a linkage to Behaviorol
Health.
2. Information Technology: Electronic Health Records: Utilize electronic health record software throughout all
clinical programs of the organization. a) Behavioral Health: launch system by July 2012. b) Public Health:
launch system by July 2013. Measurement: Short-term, utilize electronic health record software as an
organization to meet "meaningful use" requirements to qualify and receive American Recovery and
Reinvestment Act fund incentive payments. Both divisions should be ready to apply for "meaningful use"
payments within the first year after software implementation. Long-term, assure interoperability with the
regional Health Information Exchange and Early Learning Council. OR HIP
3. Quality Councils: Assure organizational commitment to quality improvement through Quality Councils.
Roles will include quality priorities and standards, workforce knowledge, use of improvement processes and
tracking and reporting performance. a) Public Health Quality Council and Behavioral Health Quality Council
in the organization or regionally with the Central Oregon Health Board by July 2012. b) If formed,
participate on a comprehensive Regional Quality Council with other health stakeholders. c) Develop
organizational competencies in use of the Plan Do Study Act improvement model through training by July
Deschutes County Health Services Strategic Plan 2.24.2012
Page 11 of 32
2013 , and each division will undertake at least two such projects by July 2014 . Measured through quarterly
reports to Central Oregon Health Board and Central Oregon Health Council. CO HIP -OR HIP
4. Focus County Behavioral Health Operations: Place County's emphasis for county-operated services on
specialty programs, safety net services and integrated services for community members with complex care
behavioral health needs. Expand points of service to increase access.
5 . Holistic Services to Improve Health: Within billing regulations and feasibility, develop fully integrated health
services (for behavioral health clients across the age spectrum) that are family-centered, evidence-based,
recovery oriented and outcome driven . Promote access by removing barriers to holistic services (i.e .,
wellness services and activities, healthy eating, nutrition, exercise, parenting, budgeting) by July 2015.
6. Public Safety Preparedness: Sustain and continue to report on essential public safety programs and services
supported by Health Services including a) 24/7 crisis services; b) co-sponsorship of Crisis Intervention
Training (growth expected); c) coordination, service or support to treatment courts; d) shared investment
with the Sheriff's Office in chemical dependency treatment; e) the civil commitment process; and f) public
health roles in emergency preparedness and response. From time to time, additional public safety work will
be considered in consultation with the Local Public Safety Coordinating Council and its members .
7 . Housing for People with Mental Illness: a) Update the Deschutes County Housing Continuum to a regional
framework by July 2013 in collaboration with the Central Oregon Health Board, Housing Works and the
Oregon Health Authority. b) Identify target population(s) and project(s) for development. c) Increase access
to rental assistance for our clients in supportive housing and independent living.
8. C)ient Engagement and Reduction in No-Show Rates: For clients seeking outpatient services, establish a
standard of three appointments in the first thirty days of service to increase engagement in the therapeutic
process. Measurement: Set baseline by January 2013. CO HIP Ensure appropriate training for staff who are
first contacts? Streamline of handoffs following initiation.
D. Reduce Cost and Increase Cost Effectiveness
Definition: Reduce the cost of health care through better health and care options . Increase efficiency and
effectiveness . Invest in strategies that best accomplish this goal.
1. Billing and Coding Audit: Utilize an external certified coding consultant to review and revise billing practices
and annually audit provider coding for accuracy. Annual, ongoing.
2. Preferred Provider Contracts: Gain preferred provider contracts with the major insurance carriers by
annually assessing the department's top 15 most commonly billed commercial payors. Execute contracts to
increase reimbursement rates and reduce patient out-of-pocket costs by July 2013.
3 . Assertive Community Treatment: a) Strengthen the Assertive Community Treatment (ACT) team including 1)
determining the necessary staffing level, and 2) expanding the use of peers to coordinate care . b) Meet the
ACT Program fidelity standard by December 2013. CO HIP
Deschutes County Health Services StrategiC Plan 2.24.2012
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4 . Children's Intensive Treatment Services (Wrap Around): Improve intensive treatment services for youth
through wrap-around services, while reducing associated hospitalization costs. Create County team to
respond in collaboration with St. Charles lVIedical Center to serve high acuity youth in need of emergency
services. Reduce the number of youth under 18 requiring hospital admissions to 1.5% (per 1,000 enrollees)
or lower annually. Note that this is a local initiative.
5. Early Assessment and Support Alliance (EASA): Reduce symptoms of psychosis, mental health crises and
hospitalizations by expanding the EASA program throughout Central Oregon. Meet the Triple Aim objective
of better health, better care and reduced costs. a) Screen and refer a minimum of 18 clients quarterly; and
b) maintain a minimum caseload of at least 28 clients while growing program service capacity. c) Continue a
reduction in state hospital admissions. Maintain level of EASA hospitalizations under 25% of total enrolled
clients. CO HIP
E. Increase Health Integration and Collaboration
Definition : Improve health practice and care by combining activities, services and care.
1. Communications with Clients: Create a program to implement secure texting (e.g., breastfeeding support,
appointment reminders) with clients by July 2012.
2. Information Technology: Remove barriers to communicating electronically with clients and community
providers . Develop or purchase information technology resources which allow electronic communication
via email, phone texts, electronic health records. Contract with external provider to offer secure webmail
with encryption that allows communication with clients. This will allow clients better communication, ease
of access, and ultimately better access. Policy developed July 2012 . OR HIP
3. Communication with the Community: Better utilize traditional and new social media outlets to ensure
broad dissemination of public health information. Measured by creating Facebook and Twitter accounts for
Health Services as well as a seasonal calendar of media releases and public service announcements by July
2013. CO HIP
4. Health Communications: Develop and implement a three-year communication plan for Health Services that
includes strategies and resources to enhance public awareness of our programs and services by July 2013.
Meet with program leaders to identify communication needs and priorities . Increase media outreach and
dedicate resources implement the communication plan.
5. Communitv Health Workers: Expand use of community health workers (including peer support) to better
coordinate care. a) Establish short-term measurement tools for behavioral health peer positions by
December 2012 . Begin tracking and reporting to Quality Councils and management. b) Develop an
operating model agency-wide including financing and effectiveness measurement, in consultation with the
Central Oregon Health Council, by December 2012 for implementation in FY 2014. c) Finalize a
development plan by February 2013 for our organization including targeted program areas. Reflect the
improvement plan in the FY 2014, FY 2015 and FY 2016 operating budgets. Measurement: 2011 DCHS
baseline: 2 peer specialists in behavioral health. CO HIP -OR HIP
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6. Coordinated Care for Health Services Clients: In an effort to better serve our clients, establish a coordinated
care model that provides easy engagement of our clients in multiple services we offer. Track clients served
by multiple programs, complaints and care experience. a) Convene an interdisciplinary team to construct a
policy, protocol and training plan by December 2012 . b) Prioritize clients for needed services across Health
Services programs to assure a "warm hand off." c) As a specialized need, develop internal staff capacity
(e.g., health worker position(s) to offer health services for specific client groups by July 2013; this will include
but may not be limited to clients with developmental disabilities.
7. Integrate Primary Care and Behavioral Health: Create integrated health homes throughout Deschutes
County to include primary care and behavioral health services. Improve access for Medicaid, uninsured and
safety net populations. a) Measure the health and care benefits of integrated services in the school-based
health centers. b) Complete 2012 expansion to include 1) primary care services at Health Services' Bend
specialty behavioral health clinic (the Annex) for people with a serious mental illness, 2) co-location and care
coordination (Mosaic and Health Services) at the Redmond Service Center, and 3) investment in behavioral
health services at Mosaic Medical's Bend Greenwood clinic. c) Improve collaboration with primary care
physicians when managing Health Services' behavioral health clients . OR HIP Linkage to Developmental
Disabilities .
8. Consulting Psychiatrist: Through leadership of the Health Services Medical Director and behavioral health
team, develop a capacity and model to offer short-term consultation to primary care practices (children and
adults) by July 2013. Critical considerations include viable funding model. CO HIP
9. Maternal Child Health: As a partnership between maternal child health and behavioral health
developmental disabilities teams, implement an integrated transition process for CaCoon clients
transitioning from adolescence to adulthood by January 2013 . OR HIP
10. Living Well: Continue to improve and sustain relationships with Central Oregon community partners to
improve access and availability to the Living Well program. Through 2015, regional referrals made by
providers and other partners will increase annually by 20%, from a baseline of 271 referrals in 2011. OR HIP
11. Immunization Exemptions: Collaborate with Bend -La Pine School District (or other school districts with
high exemptions), pediatric and family practice clinics, hospital birthing units, and parent education classes
to decrease the kindergarten immunization religious/philosophical exemption rate. Provide education and
targeted outreach to these groups by July 2013. Become more aligned with State immunization rates.
Baseline 2010-11 kindergarten religious exemption rates: Deschutes County: 9.0%; State : 5.6%.
OR HIP
12. Internship Program: Establish a formal collaboration with the Oregon State University Master of Public
Health Program and OSU Cascades Extension Office by September 2012. Establish a Master of Public Health
Internship program with regular student rotations at Deschutes County Health Services. Expand program to
include at least one additional institution no later than September 2014. Note: Any direct service activity
will require assurance of ability to serve, document and bill for such service. CO HIP -OR HIP
13. Parent-Child Interaction Therapy: Increase capacity for Parent-Child Interaction Therapy throughout
Deschutes County in conjunction with LAUNCH. Collaborate with community partners (Department of
Human Services, Family Access Network, KIDS Center, Mtn. Star Relief Nursery, etc.) to identify at-risk
families and youth ages 2-8 to actively participate. Provide training for minimum of eight therapists within
Deschutes County Health Services Strategic Plan 2.24.2012
Page 14 of 32
County and in practice in community 2014. Increase positive interactions between family members with a
measurable baseline by July 2012.
F. Pursue Excellence
Definition : Maintain standards of practice and performance that ensure accountability and peak performance
to operate effectively and keep our communities safe and healthy.
1. Health Assessment Capacity: By July 2013; a) Create the capacity to serve as the regional hub for the
collection, analysis, interpretation and dissemination of primary and secondary health related data to guide
programmatic decisions, resource distribution and gauge outcomes. b) Launch a web-based regional and
community health data site with shared investment and public health leadership. Note: Recommended as
an initiative of the Central Oregon Health Board. CO HIP -OR HIP
2. National Accreditation: Receive accreditation from Public Health Accreditation Board for all three Central
Oregon public health agencies by July 2014. CO HIP -OR HIP
3. Environmental Health: Assure that Deschutes County's Environmental Health Program meets seven of the
nine standards of the Food and Drug Administration Voluntary National Retail Food Regulatory Program by
July 2015.
4. Behavioral Health Outcome Tools: Measure therapeutic outcomes and increase diagnostic expertise.
Through the Central Oregon Health Board, identify specific outcome tools to be used by all behavioral health
providers in the Central Oregon provider network by January 2013. CO HIP
G. Expand Regional Efforts
Definition : Collaborate with local and State governments, our hospital system, local providers, private insurers,
health collaboratives, our community and the people we serve.
1. Regional Health Coordination Among Counties : Provide leadership in the development of the Central
Oregon Health Board. Develop and expand regional services offered through our three counties.
a) Complete an inventory of regional programs shared by Central Oregon counties by December 2012. b)
With our Coordinated Care Organization, help create a Health Board unit to coordinate and improve the
Central Oregon behavioral health system to benefit all communities in the region. Emphasize service to
Oregon Health Plan members and indigent residents of the region. To include tracking of core metrics at
least semi-annually. Form by October 2012 . c) Through the Central Oregon Health Board, adopt (by March
2012) and implement a regional 2012-14 work plan to improve health and care as well as increase efficiency .
Measurement: Quarterly reports. Measurement: Track of work plan deliverables; new resources and
successful project completion . CO HIP -OR HIP
2. Health Information Exchange: Within HIPAA gUidelines and Exchange protocols, include County client data
by June 2015. Benefits include public health analysis of population data, individual access to personal health
information and an ability to meet Federal "meaningful use" requirements. Health Information Exchange is
defined as the mobilization of healthcare information electronically across organizations within a region,
community or hospital system. CO HIP -OR HIP
2.24.2012 Deschutes County Health Services Strategic Plan
Page 15 of 32
3. LAUNCH: The LAUNCH Program will implement and evaluate an early childhood wellness media campaign
to help unify the early childhood wellness service community and to educate and mobilize the public and
policy makers around the issue, reporting to the Public Health Advisory Board by July 2012 . CO HIP -OR HIP
4. Emergency Preparedness: By July 2013, develop regional liability protections for activation of Public Health
Reserve Corp volunteers when mutual aid is requested in an emergency. Note: Includes Central Oregon
Health Board, local health departments and tribal governments. CO HIP
5 . Regional Nurse Family Partnership: Implement regional Nurse Family Partnership home visiting program,
serving at-risk families with young children. Maintain caseloads (2012: 138 clients for Deschutes, Jefferson
and Crook), establish a regional Advisory Council and identify diverse funding streams . Expand capacity to
meet the demand for service . Measurements: a) perinatal outcomes for the three Central Oregon counties
posted on web site annually, b) number served. CO HIP
H. Strengthen our Organization
Definition : Build the internal infrastructure necessary to create a robust, healthy and flexible organizational
environment which fosters teamwork, progressive thinking and cutting-edge programming.
1. Organizational Structure: At least biennially, evaluate our organizational capacities and structure to assure
that we are efficiently and appropriately staffed and organized to accomplish our goals . a) Hire a Behavioral
Health Division Director to manage day-to-day direct service operations related to mental health, chemical
dependency and developmental disabilities by July 2012 . b) Reassess the organization and structure with
Department leadership by December 2013 and December 2015 .
2. Integration: Annually, offer integrated activities for public health, behavioral health and support personnel
(e.g., joint staff meetings, collaborative program discussions, cross-training or presentations between
programs). Includes but is not limited to: Charter and convene periodically a "Support Staff' Team to
strengthen Department processes and communication as well as help execute special projects by July 2012 .
3. Emergency Preparedness : In conjunction with the public health preparedness program, develop a
behavioral health preparedness capacity including: a) Train essential staff serving vulnerable populations
(e.g., teams serving people with a serious mental illness, crisis personnel) by December 2012. b) Name a
behavioral health preparedness team and leadership position by November 2012 . c) Incorporate the team
into the Incident Command System Structure through requisite training by July 2013.
4. Streamline and Strengthen Staff Development: In an effort to strengthen our work force and their ability to
perform their work, a) Develop and implement a new employee orientation for new Health Services
employees by July 2013. Include attention to documentation required, licenses, system access, team
orientation, payroll, etc. b) Develop and implement a supervisory orientation for new managers and
supervisors by January 2013 . c) Develop and implement an employee exit interview process complementary
of the County's process; analyze results annually during the fall Strategic Plan review and work plan
development process by January 2014.
I. Promote Sound Health Policy
2.24.2012Deschutes County Health Services Strategic Plan
Page 16 of 32
Definition: Advocate and support clear, overarching policy interests and expectations for population health
and the region's health care system.
1. The Triple Aim: Health Services will promote and advance the Triple Aim. We will support programs,
services, practices and activities that lead to "better health, better care and less cost" across the health
system. Note: The Triple Aim is now part of Oregon law and a founding concept for the Oregon Health
Authority. It has been adopted by the Central Oregon Health Council and Deschutes County Health Services .
2. Regional Development: Deschutes County, through Health Services, will use a regional approach to program
development, direct services, resource management and advocacy when the Department determines that
the benefit to our County and our residents outweighs any associated costs. Criteria for assigning benefit to
a regional project include a) a tipping point where we can accomplish something as a region that is less likely
to be accomplished when done by a single County, b) an ability to increase resources and expand services, c)
better coordination with regional organizations, d) greater efficiency, and/or e) improved education and
advocacy. These initiatives will most often focus on Central Oregon counties through mutual agreement of
all parties. Whenever Deschutes County takes a regional approach to its health work, we will identify the
benefit of regionalization.
3. Strategic Plan and Regional Health Improvement Plan as Core County Documents: As a matter of policy, the
Strategic Plan and the Health Improvement Plan provide a set of principles, policies, priorities and positions
that reflect the direction of the Deschutes County Board of Commissioners. Within State or County
guidance, Health Services will advance the principles, policies and priorities contained in these plans, subject
to any further direction or guidelines set forth by the Board . A progress report on our success in
implementing the Strategic Plan shall be provided to the Board at least biennially.
4. Adherence to Policies : Health Services will operate within statutory, administrative rule and grant
requirements as well as County and Department policies. Additional guidance for our work will also be
established, when helpful, at the division and program levels. Policy guidance will be posted for staff, and
supervisory staff will work to assure staff are aware of and operating within these policies.
S. Public Health Policy Approach: Through 2015, Health Services will collaborate with local agencies to reduce
the burden of chronic disease in Deschutes County by way of policy, systems and environmental change.
We will: a) use data to develop and implement health related policies to address priority population health
needs and disparities; b) inform decision makers and stakeholders about potential health impacts of
proposed plans, projects or policies wherein health is not a consideration; c) promote no-and low-cost
community resources that support health related policies; and d) collaborate with land use and
transportation agencies on projects that impact population health (e.g., Health Impact Assessments,
membership on Regional Transportation Planning steering committee and active transportation initiatives).
OR HIP -CO HIP
6. County-Operated Behavioral Health Services: Health Services will continue to focus County-operated
programs and services in areas where the Department has particular skills and expertise and where the
Central Oregon Health Board determines our work is most beneficial. By policy, we will also work with the
Health Board to advance a network of agencies and services for outpatient care and treatment when such
options are a) of high quality, b) more cost effective and/or provide for consumer choice. In such instances,
Health Services will serve as one of several agency options or will refrain from offering such services, based
on the direction of the Central Oregon Health Board and/or the Deschutes County Board of Commissioners.
2.24.2012Deschutes County Health Services Strategic Plan
Page 17 of 32
7. Resiliency and Recovery in Our Behavioral Health Practice: Health Services will promote resiliency and
recovery for people of all ages who experience developmental disabilities or psychiatric and/or substance
abuse disorders. Policies and procedures governing service delivery will attend to factors known to impact
individuals' resilience and recovery . This work will include:
a. A high quality of life for each individual or family;
b. An ability to develop and maintain social relationships;
c. Inclusion as a member of the community;
d. Participation in community activities of the individual's choice;
e. Improved health status and function;
f. Success in work, school or living situation; and
g. An ability to measure our success in implementing this policy .
This will be achieved by providing services that are:
a. Client directed. The provider will work in partnership with the client. The client will identify
personal goals and have control of the resources to achieve these goals.
b. Individualized and client centered. The plan for reaching goals will be designed to meet the specific
needs and strengths of each individual.
c. Empowerment. Services will be delivered to support and educate the individual to be able to plan
for and direct his/her own services.
d. Holistic. Services will encompass all the aspects of an individual's life. Services will address client
identified needs such as housing, employment, community participation, transportation, family
involvement, education and treatment for health, mental health and addiction issues.
e. Strengths based. Providers will work with clients to identify the inherent strengths of each
individual and build on those strengths to achieve the identified goals .
f. Peer support. Services will be designed to encourage peer support including sharing of experiential
knowledge and social learning.
g. Respect. Respect will be the basis of all relationships with clients. We will treat each individual with
respect. We will work to ensure that the individual's rights are protected, to eliminate
discrimination and stigma, to assist the individual to regain or maintain self-respect and to
encourage the individual's participation in all aspects of life.
h. Hope . Services will convey the motivating message of a better future. Both the client and the
provider believe that things can get better, barriers can be overcome and goals can be achieved.
Visually move this up in list
8. Integrate Primary Care and Behavioral Health: Through the Central Oregon Health Board and Central
Oregon Health Council, we will develop integrated behavioral health and primary care settings. We will
evaluate various models including care through a) co-location of County personnel, b) contracted behavioral
health providers, and c) primary care employment of behavioral health personnel. Note: all three models
are under development in 2011-12. OR HIP
9. Tobacco Cessation Billing: Health Services will work with the Central Oregon Health Board and PacificSource
to establish an approved method to bill for tobacco cessation treatment for behavioral health clients. With
a viable billing option, we will begin offering tobacco cessation groups for mental health and alcohol and
other drug clients by December 2013. CO HIP -OR HIP
2.24.2012 Deschutes County Health Services Strategic Plan
Page 18 of 32
10 . Tobacco Policy: Exposure to second-hand smoke can lead to heart disease, cancer and many other diseases.
Bans on smoking in public places, including all indoor workplaces, protect people from the harms of second
hand smoke, help smokers quit and reduce youth smoking. a) Implement a 100% tobacco-free campuses
policy at all Deschutes County facilities and all local government properties. b) Assess the desire for
downtown tobacco-free campuses in Bend, Redmond and Sisters. c) Coordinate a regional approach to
collect data on tenants of multi-unit housing and their preferences toward smoke-free housing and smoke
free multi-unit properties. d) Work toward implementation of smoke-free multi-unit housing properties. e)
Assist in implementation of tobacco-free policies where people connect with physical and mental health
services or support. OR HIP
11. Breastfeeding Policy Advocacy: a) Collaborate with community agencies to strengthen place-based (e.g.,
child care facilities) obesity prevention poliCies and practices that address nutrition, physical activity, screen
time (e.g ., computer, television) and breastfeeding. b) Advocate that a mother's infant feeding decisions be
supported and protected in a variety of settings. c) Through WIC program investment, promote the Baby
Friendly Hospital designation at St. Charles Bend and Redmond by July 2013 . d) Educate the public and at
least ten employers about Oregon's breastfeeding laws and regulations by July 2014. OR HIP
12. Nutritional Guidelines: Assure availability of healthy foods in Health Services' worksites. Develop and
implement nutritional guidelines for foods and beverages available to Department staff, clients and visitors
through 2015 . a) Adopt a healthy vending machine policy that sets nutrition standards for foods sold in
vending machines in Deschutes County agencies. b) Create guidelines for healthy foods and beverages at
County sponsored meetings and events. c) Expand the Farm to Work program to include additional drop
sites, a comprehensive outreach campaign and more educational opportunities related to healthy nutrition.
OR HIP
13. Community Based Service Options: Deschutes County supports the concept of a community system of care
through which County residents have local access to a wide range of health services. On a case-by-case
basis, it is understood that an out-of-area placement for some health services may be necessary though it is
not usually as beneficial as an effective local option that allows continued family and community
involvement and a smooth transition to local services and supports.
2.24 .2012 Deschutes County Health Services Strategic Plan
Page 19 of 32
Appendix i.
Membership of the Strategic Planning Group
Public Health Accreditation (Measure 5.3.1 A 1. a .)
We are grateful for the support and contributions of our Department leadership and staff in the development of
this Strategic Plan. Participating leaders included Dana Bennett, Kacy Burgess, Cherstin Calion, Kathy
Christensen, Jim Denman, Kathy Drew, Jeff Emrick, Shelly Falconer, Barrett Flesh, Lori Hill, Kathe Hirschman,
Scott Johnson, Tom Kuhn, Maggi Machala, Tim Malone, Virginia Mayhill, MaryAnne McDonnell, Jean
Mendenhall, Eric Mone, Kate Moore, Sherri Pinner, Travis Sammon, Terry Schroeder, Elaine Severson, Laura
Spaulding, Martha Steigleder, Karen Tamminga and Patricia Thomas.
Both our Advisory Boards also contributed to this plan , offering feedback and suggestions throughout the
construction and approval process . These individuals included:
Advisory Board Participants
Public Health Advisory Board
Kim Curley-Reynolds, Chair
Commute Options
Jock Pribnow, Vice Chair
Retired Ph ysic ian
Anthony Rosenthal
Retired Physician
Keith Winsor
Ac ademy Medical Sy stems
Cynthia Barnes
OHSU Dentistry Sch ool
Mike Bonetto
Health Policy Advisor, Governor Kitzhaber
Eric Alexander
Partners in Care
Jane Dey
Re tired RN (Public Hea lth)
Blake Drew
Fami ly Dental Care
Charles Frazier
Ret i red Pharma cist
Holly Remer
Healthy Beginn ings
Katrina Wiest
Bend La Pine Sc hool Distric t
Susan Keys
Inspire USA Foundation
Behavioral Health Advisory Board
Glenda Lantis, Chair (2011)
Central Oregon Commun ity College
Darrel Wilson, Chair (2012)
Opportunity Foundation of Central Oregon
Pat Croll
Re tired Ge ri atric Specialist, Provider
Jay Harris
Telecare Mental Health Services of Oregon
Chuck Hemingway
Desc hutes Family Recovery
Marty Miller
Bend-La Pine Schools Sp eci al Education
Roger Olson
NAMI of Central Oregon
Kristin Powers
St. Charl es Health System
Lee Ann Ross
Retired Economist
Julie Rychard
Full Access Brokerage
Lindsay Stevens
Vocational Rehab i litation Counselor
Marianne Straumfjord
Retired Psychiatrist
Bert Swift
Retired Professor of Healthcare Administration
Aylett Wright Patricia von Riedl
Community Volu nteer, COCC Peer Specialist, Deschutes County Health Servi ces
2.24.2012Deschutes County Health Services Strategic Plan
Page 20 of 32
Appendix ii.
Strategic Planning Process
(Public Health Accreditation Measure 5.3.1 A 1. b.)
Introduction: Strategic planning in Deschutes County was launched in 2011 during a time of rapid change in a
dynamic health reform environment. With an application for Public Health Accreditation on the horizon, we are
collaborating with the community on a Regional Health Assessment, an update of our 2009 Health Report and a
Regional Health Improvement Plan for Central Oregon. The strategic planning became a final step to guide
Deschutes County's work in public and behavioral health. A more detailed summary of the process follows:
1. Accreditation Beta Site: In May 2010, Deschutes County hosted the nation's first site visit from the Public
Health Accreditation Board, an important step in a major effort to strengthen our nation's public health
system.
The goal of public health accreditation is to improve and protect the health of the public by advancing the
quality and performance of all health departments in the country, so that residents can feel confident that
their public health department is providing the highest quality services possible. Deschutes County was one
of the 19 local health departments chosen to beta test the accreditation process in 2009 through 2010, and
the first site in the nation to go through a beta accreditation site visi,t. Participation in this process has
positioned Deschutes County Health Services to be better prepared for the official accreditation process
through the identification of deficiencies and proficiencies.
2. 2009 Health Report: In 2009, a private consultant was contracted to begin assembling a health report
specific to Deschutes County. The purpose of this report is to provide region-specific data that can be used
by local government and community agencies, health care providers, school districts and other interested
community members and groups to help identify and better address the health needs of Deschutes County
residents. The health indicators examined in this report are used to represent trends by tracking
measureable changes over time. The report identifies health areas where Deschutes County has met or
improved in state or national health objectives, as well as areas in need of improvement. This report was
utilized as a starting point for staff in creating goals to work toward in the current planning cycle. Also, this
serves as the foundation for the current Regional Health Report which is being developed concurrently with
the 2012-2015 Strategic Plan.
3. Central Oregon Regional Health Assessment Advisory Group: -Regional planning began informally in late
2010 when regional stakeholders formed a Regional Health Assessment committee in order work toward
the common goal of having access to health information needed to guide programming decisions. This
group formed to accomplish multiple tasks including identifying a web-based health indicator tool to be
used by all health systems and the community, helping to guide the development of a Regional Health
Report and preparing for the creation of the Regional Health Improvement Plan. The focus and direction of
these initial meetings has evolved into a core group of regional partners working together toward common
goals and serving as a committee of the Central Oregon Health Council.
4. Regional Health Report Update: In the fall of 2011, hours were secured for an in-house Research Analyst to
update the Deschutes County 2009 Health Report and create a Regional Health Report using funding from
the Accreditation Support Grant. The Analyst has presented updated health report data at regular intervals
to our Behavioral and Public Health Advisory Boards, the Regional Health Improvement Plan Committee and
Deschutes County Health Services Strategic Plan 2.24.2012
Page 21 of 32
to County Commissioners. Feedback received from these interactive presentations led to identifying ten top
priority areas to be addressed by the Regional Health Improvement Plan as well as for Deschutes strategic
planning. Although work is often driven by available funding streams, it is important to look at local health
data to guide the future direction of service.
5. Regional Health Improvement Plan: In 2011, the Central Oregon Health Council began driving the formal
process of creating a Regional Health Improvement Plan (RHIP) to be utilized by Crook, Deschutes and
Jefferson counties. The development of the RHIP took place concurrently with the Deschutes strategic
planning process, making it possible to effectively align priorities and target areas between the two plans.
This document was completed in March 2012 and effectively links regional goals with County-specific goals.
The Regional Health Report update data was used to develop the ten priority areas in the development of
the RHIP.
6. Strategic Planning Process:
a. Process
i. Mission, Vision and Guiding Principles -Deschutes County Health Services Director Scott Johnson
created the mission, vision and guiding principles for the plan.
ii. SWOT Analysis -During a retreat with Department management staff in the fall of 2010, an agency
SWOT Analysis was conducted. This analysis was examined as another guiding point for
management when looking at which goals best met the community and agency needs. The
document in the appendix entitled "Ten Likely Environmental Changes in 2012-2015" further
examines external factors that will affect future public, behavioral and clinical health care delivery.
iii. Domain Creation and Development -Health Services management selected and then defined nine
domains which they felt brought together the elements of the Triple Aim concept in addition to the
essential components needed to successfully position the agency for health reform. These domains
serve to broadly classify the working elements of the plan to ensure that gaps do not exist globally.
iv. Staff and Workgroup Input -Using the Deschutes County 2009 Health Report and the current
Regional Health Report Update as initial data, strategic planning work began with staff input. Staff
worked in small groups to brainstorm and identify agency priority areas to focus on from 2012-2015.
These workgroup sessions began to populate the nine domains with goals that they felt would
benefit the community and agency over the next four years. Some goals were specific to behavioral
health, some to public health and some to both. At times, work sessions took place during meetings
of management staff, program staff and at a combined meeting of our Behavioral and Public Health
Advisory Boards.
v. Workgroup Process -Workgroups met in two designated "planning rooms," where the nine
domains were written on poster boards on the walls of the meeting rooms. Staff wrote out
potential goals on "Post-It" style papers and adhered the goals to the poster boards under the
specific domains under which their goals most appropriately fell. Following approximately four
weeks of time to allow staff to populate the domains, the domains were collected and goals typed
into the template of the StrategiC Plan. Staff participation and response to this open process was
very positive and produced an overabundance of goal areas to incorporate into the plan.
vi. Stakeholder Input -Once the draft tem plate was completed, a process of vetting the information
through the Behavioral and Public Health AdviSOry Boards, regional partners, County Commissioners
and Department leadership teams began. The Advisory Boards are comprised of area health
professionals, partners and community members, which provided a broad spectrum of expertise
and experience to contribute to the plan. Minutes were taken during each review by the various
groups, and feedback was incorporated into the plan . Simultaneously, previous and current health
2.24 .2012 Deschutes County Health Services Strategic Plan
Page 22 of 32
data was provided to stakeholders by the in-house Research Analyst to assist in identifying gaps in
the plan.
b. Oregon Regional Health Improvement Plan -The Oregon Regional Health Improvement Plan was
examined in detail and compared with the goals of the Strategic Plan to identify where there was
alignment and where gaps existed. There was a reasonable amount of overlap; however, there are
areas which the Oregon Health Authority has the capabilities and resources to address which are not
feasible locally. This comparison document is available for review .
c. Timeline -The 2012-201S?trategic Plan Timeline (Appendix ii.a.) contains the complete macro level
agenda specific to strategic planning including the groups of staff, community groups and regional
partners who participated in the process. Minutes for these meetings were recorded to document input
and feedback utilized to develop the plan.
d. Annual Planning Cycle -The Annual Strategic Planning Cycle (Appendix ii b) visually demonstrates the
annual process that Health Services will engage in throughout the duration of this plan . To be successful
the plan must be examined annually to align the annual work plan with goals and budgets, review and
compare with legislation, examine new emerging health data and evaluate progress of the plan. This
diagram also contains a long-term timeline which will designate when final evaluation of the plan will
take place along with planning for the next strategic planning cycle.
2.24.2012 Deschutes County Health Services Strategic Plan
Page 23 of 32
Appendix ii a.
2012-2015 Strategic Plan Timeline
Deschutes County Health Services
Date Item/Meeting Outcome
Sept 16 Deadline for program areas to submit
goals for Strategic Plan
-Mission/Vision/Values
-9 Strategies & Goals
Sept 20 1st Draft completed (rough)
Sept 20 PH Leadership Team Review of 2008-11 Strategic Plan
Sept 21 BH Advisory Board -Review of Strategic Plan
-Health Assessment update
-Review of 2008-11 Strategic Plan
Sept 26 Management Team
Sept 28 PH Advisory Board
Oct 12 Board of County Commissioners -Health Assessment update
BH & PH Leadership Meeting -Review Draft
Oct 26 Combined BH & PH AdviSOry Board
Meeting
Review & Edit Strategic Plan
Oct 31 Management team retreat -Review & Edit Strategic Plan
-update SWOT Analysis
Nov4 2nd Draft completed
Nov8 PH All staff
BH All staff
Share with staff
Nov 15 Review by Kuhn & Emrick Detailed Editing
Nov 16 BH Advisory Board Review if needed
Dec 07 PH Advisory Board --Strategic Plan update
-Health Assessment update Dec21 BH Advisory Board
Dec-Mar Central Oregon Health Council Health Improvement Plan
2012
Jan -Feb BH & PH work on FY 2013
Work Plan
2012-13 Work Plan Draft
Jan 3 Regional Health Improvement Plan
Committee
Health Assessment Review and input (top
10 priorities)
Jan 18 BH Advisory Board Health Assessment Review and input (top
10 priorities) Jan 25 PH Advisory Board
Feb 7 Final Draft completed (all input due)
Feb 15 BH AdviSOry Board _1 st Read of Plan
Feb 22 PH Advisory Board
Feb 27 Board of County Commissioners Work Session to present Strategic Plan
and review
Mar 21 Combined BH &PH Advisory Board
Meeting
-Adopt Strategic Plan
-Adopt 2012-13 Work Plan
Mar Central Oregon Health Council Health Improvement Plan completed
Mar Sherri -budget Actions & Measures to Dave Inbody
Mar Board of County Commissioners Adopt Strategic Plan
2.24 .2012 Deschutes County Health Services Strategic Plan
Page 24 of 32
Strategic Plan
Fall
-+ Evaluate Strategic
Plan Progress
-+Review Health
Report Data
..
Central Oregon Health
Board
County Commissioners
Public & Behavioral
Health Advisory Boards
Community Partners
Spring
-+Budgets Aligned
with Plan Priorities
-+ Adoption of Plans
and Priorities
Summer
-+ Review Legislative
Session Outcomes
-+ Begin implementing
Work Plan
Regional Health '09 Health Strategic Regional Health Strategic Accreditation Strategic
Assessment Report Analys is Planning Health Improvement Plan Application Planning
Planning & Update Process Report Complete Plan Complete Adoption Process
2012
contrl'lUOlB"RegfonafKetmrRfpm OP9U1'II
Strategic Plan Upd ating as needed
2013 2014 2015 2016
Annual
Strategic
Planning Cycle
Winter
-+Create Annual Work Plan
-+ Review Regional Health
Improvement Plan
-+ Make Adjustments to
Appendix ii b.
Deschutes County Health Services Strategic Plan 2.24 .2012
Page 25 of 32
Appendix iii.
Accomplishments in Recent Years
Over the past eight years, previous St rategic Plans, grant applications and program development efforts have
resulted in considerable growth i n our services and our contributions to our communities and our region .
"Better Access to Help" for People in Need
a. Increased community behavioral health services for Oregon Health Plan members through employees and
contracts as members increased 211% from 8,134 (2004) to 25,340 (2012).
b. Increasing mental health options by end of 2012 by certifying and funding six more mental health agencies
since 2004. Authorized help for 649 people in 2011 alone .
c. With Building Services, secured State and Mosaic Medical commitments to open an extensive integrated
Redmond Service Center in the summer of 2012.
d . Expanded Health Services school-based health centers to six centers, opened new centers in Sisters and
Redmond (High School). Note : Includes Gilchrist center in North Klamath.
e. With Deschutes County grant writer, secured a Federal grant application to construct a new mUlti-purpose,
integrated health center in Sisters to serve children and seniors .
f. With the support of the Klamath County Board of Commissioners, assumed responsibility for helping Oregon
Health Plan residents in Gilchrist, Chemult and Crescent.
"Better Health" for County Residents
a. As the County's public health agency, contributed to favorable county health ran kings. Deschutes County
ranks 4th of 33 Oregon counties in health factors; 7th in health outcomes.
b . Deschutes County ranked first of all Oregon counties in "health behaviors" (measures of smoking, diet and
exercise, alcohol use, and risky sex behaviors).
c. With all area school districts, became the first Oregon County to develop new policies and implement My
Future My Choice (sexuality education) in middle schools countywide; secured a regional grant to
implement Cuidate , a prevention program for latino youth.
d. Expanded immunization capacity with local private and public clinics, helping to assure access and education
about vaccine. In 2010, added Mosaic Medical's Bend Clinic as a delegate clinic; increasing free vaccine for
people at high risk .
e. Promoting worksite wellness in the community; sponsored an agency Health Improvement Committee .
Continuing to pilot a farm to work program and offering other improvements.
1Jetter Care and Safety" for Our Community
a. Beginning in 2011, co -sponsoring a best practice, regional Nurse Family Partnership program, improving
maternal and child health for high-risk families in Central Oregon .
b. Created our first Community Health Worker positions; employed two peer support specialists in our
Behavioral Health Division, preventing ill health and coordinating services .
c. Beginning in 2011, created a new Quality Improvement Program addressing access, critical incidents, client
concerns; sponsoring projects focused on better health and care .
d. Successfully transitioned Deschutes County Environmental Health to Deschutes County Health Services,
integrating the staff and services with our Community Health team.
e. In 2010-11, completed the largest increase in residential options for people with mental illness in the
County's history (48 more units/slots), preventing homelessness, hospitalizations, improving health and
safety and reducing costs .
2.24 .2012 Deschutes County Health Services Strategic Plan
Page 26 of 32
f. Providing key health role in County emergency preparedness; staged successful emergency preparedness
exercise with the u.s. Postal Service, health providers and law enforcement with a health site at DCHS for
affected workers .
g. Offering a best practice Parent Child Interaction Therapy program, improving parent child interactions and
preventing abuse and neglect.
ULess Cost" for Our Health Services in Oregon and Nationwide
a. Continuing to expand Living Well, a regional, evidence-based chronic disease program, helping Central
Oregon residents of manage chronic conditions and lessen hospital stays.
b. Sponsored and expanded our regional early intervention Early Assessment &Support Alliance program;
helping transition age youth experiencing psychosis for the first time. Offers better care and reduces
hospitalizations .
c. Helping people return to the community from the State Hospital; participating in Oregon's new AMHI (Adult
Mental Health Initiative). Reduces hospital stays and improves care.
d. Developed a new best practice Assertive Community Treatment team, improving care with 24/7 behavioral
health service for people with severe mental disorders.
e. Developed and strengthened our Children's Wrap Around team, offering intensive community services to
high-need children with serious emotional disorders. Assures better care and reduces hospitalizations and
out of community placements.
# A Better Community and Regional System" During a Time of Health Reform
a. Implemented a five-year federally funded Linking Actions to Unmet Needs in Children's Health program,
enrolling more than 100 at-risk children and families. Integrated services are provided by a multi
diSCiplinary team with a nurse practitioner, mental health therapist and Family Access Network advocate.
Strengthens families and prevents abuse.
b. With the Commissioners, formed a regional Health Board to replace Accountable Behavioral Health Alliance
(five-county Behavioral Health Organization); developing regional services among counties for greater
efficiency, an increase in resources and better services.
c. Helped pass SB 2004, forming Central Oregon Health Council to serve as community governance over State
required Coordinated Care Organization (HB 3650 2011 session).
d. Recognized as a State of Oregon demonstration site for service integration in partnership with the hospital
system, insurance groups and health providers.
e . As a region, lead organization(s) for health assessment; launching community web site with health
assessment data by January 2013 to increase community awareness and response.
IIA Stronger County Departmentil with a Focus on Accountability
a. First county in nation to participate as a beta site for public health accreditation through the Public Health
Accreditation Board; improving our operations through this process.
b. Successfully completed the State Public Health Triennial Review. Addressed all findings and
recommendations, completing the process in September 2010.
c. Continuing improvements and integration in our business services area with greater emphasis on billing
systems and processes, critical business functions as part of health reform.
d. Improving our health record system with new technologies; implementing Unicare system in behavioral
health in 2011; preparing to select and implement the OCHIN system in public health in 2012-13.
2.24.2012Deschutes County Health Services Strategic Plan
Page 27 of 32
Appendix iv.
Ten Likely Environmental Changes in 2012-15
1. Regional development. The C. O. Health
Council , a new Coordinated Care Organization (CCO)
and the C. O. Health Board (counties) as well as
limited funding and the numerous other regional
groups in Central Oregon all point to an expansion of
collaborative work across the three-county area.
2 . A shared goal of care coordinationl
with clients and between providers.
Integration of primary care and behavioral health
care throughout Central Oregon and a close working
relationship with Federally Qualified Health Clinics
(Mosaic Medical, La Pine Community Health Clinic).
3 . Formation of a Coordinated Care
Organization in our region. Our ceo will
manage all Medicaid and Medicare-Medicaid funds.
This role may expand in the future to more publ ic
and commercial business including PEBB and OEBB 2.
PacificSource may become a major player in this
work. Our Medicaid behavioral health work will
transition to the Central Oregon Health Board .
4. National accreditation of the Three
Public Health agencies in Central
Oregon. This will improve our practice and make
us more compet i tive for grants . It will require
ongoing improvement and reporting efforts.
s. Oregon Health Authority Addictions &
Mental Health Div. system change.
Beginning in July 2012, State General Funds for
behavioral health will require a common statewide
system of core services, global budgeting, a new
statistical reporting platform and accountability for
outcomes . Service Elements will end.
1 Coordination will particularly focus on improving our
DCHS clinical work with primary care practices and the
hospital as well as between public health, public health
clinical and behavioral health .
2 Public Employee Benefit Board and Oregon Education
Benefit Board.
Deschutes County Health Services Strategic Plan
6. Outcome based systems and greater
accountability required. The State plans to
move to a global budgeting model with payment
made based on outcomes achieved . Fee for service
payments may go by the way side. Failure to
perform (evidence of measurable outcomes) may
result in lost funding.
7. Health insurance coverage for 95% of
Central Oregon residents in 2014.
Federal reform and the national movement toward
health insurance exchanges (see SB 99 in Oregon)
will provide coverage to most uninsured. Working
poor could still struggle for access .
8. A potential crisis in health care. While
more people will be insured, we may lack the
primary care provider capacity to serve people . If
new payment systems are difficult for providers,
people could be excluded from service. Access will
remain a critical issue in our County . We must
assure timely access to quality care.
9 . Changes in professions and the need
for work force development. We will see a
continuing push for people to work at the top of
their licenses and the emergence of a new work
force : "community health workers" (i.e., para
professionals (including peer support specialists)
who help to coord i nate care.
10 . Unknown changes in the roles of
County government (in the areas of health
and human services). The roles as the "local mental
health authority" and the "public health authority"
are increasingly uncertain over the next several
years. Work on safety net issues will remain as the
community continues to turn to County government
to help with social, health and safety issues that
must be addressed.
2.24 .2012
Page 28 of 32
Appendixv.
COMMUNITY HEALTH
ASSESSMENT for PUBLIC
HEALTH ACCREDITATION
Conduct and disseminate
assessments focused on
population health status
and public health issues
facing the community
*Focus: Systematic
monitoring of health status;
collection, analysis, and
dissemination of data; use of
data to inform public health
policies, processes, and
interventions; and partici
pation in a process for the
development of a shared,
comprehensive health
assessment of the community.
DOMAIN INCLUDES FOUR STANDARDS:
1. Participate in or Conduct a Collaborative Process Resulting in a Comprehensive
Community Health Assessment.
2. Collect and Maintain Reliable, Comparable, and Valid Data That Provide Information on
Conditions of Public Health Importance and On the Health Status of the Population.
3. Analyze Public Health Data to Identify Trends in Health Problems, Environmental Public
Health Hazards, and Social and Economic Factors That Affect the Public's Health.
4. Provide and Use the Results of Health Data Analysis to Develop Recommendations
Regarding Public Health Policy, Processes, Programs, or Intervention.
·Public Health Accreditation Board (2011). Standards & Measures, V 1.0, May 2011 . http://www.phaboard.org/ pg. 9.
-----------
Appendix vi.
In conjunction with the Central Oregon Regional Health Improvement Plan, ten priority areas were
identified from the Regional Health Report. They will serve as a driving force in planning and
community action. The complete Central Oregon Regional Health Report, with all indicators and data
elements, will be available at http:Uwww.deschutes.org!Health-Services.aspx in late March 2012.
Regional Health Improvement Plan: 10 Priority Areas
(The following items are not listed in order of importance])
1. Disparity/Inequity
Comparative mortality ratios in areas of Southern Deschutes County and Northern Jefferson County
are significantly higher than state average, and are considered a health disparity (or difference) in
health. Mortality in this case is related to geographic area. But the disparity is also inequitable
because it is avoidable and unjust. It is no surprise to many Central Oregonians that our rural areas
have high rates of poverty, less access to services, greater distances to travel for needed care, and
many individuals struggle to meet basic needs. These systematic barriers needlessly impact
individuals' health. This is one example of disparity and inequity in our region. Many other disparities
exist, warranting investigation to determine if these differences are equitable and just or not.
Improving public health will require work toward health equity-aiming for communities where all
individuals have the opportunity to attain their full health potential, and no one is disadvantaged from
achieving this potential because of socially determined circumstance.
2. Access to Resources
The ability to access resources, services or assistance is impacted by numerous factors including
transportation, travel distance and time, finances, social and cultural barriers, waiting time, and the
systems of care in place. An elderly person living alone and unable to drive may have financial means,
but limited access to care. Similarly, a working single mother with no car may have access to public
transportation, but cannot afford the cost of unpaid leave from work to access resources. Central
Oregon's rural and urban population: More than 41% of Central Oregonians live in unincorporated
areas and towns with less than 2,500 people.
3. Early Childhood Well ness
A child's growth begins in pregnancy and continues into adulthood. Many factors impact childhood
well ness: social, environmental, physical, cognitive. Children in environments unable to meet their
needs have increased risk for poorer health, safety, development, and ability to learn . These unmet
needs during childhood pose threats to health long into adult and later life. Early childhood well ness is
a short-term investment for today and a long-term investment for the business, health, education and
social sectors in decades to come.
2.24.2012Deschutes County Health Services Strategic Plan
Page 30 of 32
4. Food Insecurity
Crook and Jefferson counties were among the top five Oregon counties with highest food insecurity.
Deschutes County has the largest total number of food insecure individuals in Central Oregon. In
Crook County, the average cost per meal is nearly $1 higher than in Deschutes County and the rest of
Oregon. It is estimated that more than 37% of children in Jefferson and Crook counties may be food
insecure. In Deschutes County, of all the food insecure adults and children, 45% are not eligible for
SNAP (Supplemental Nutrition Assistance Program) or other federal food programs-a sizeable number
of children and adults who may not be able to access much needed assistance.
5. Oral Health
Though frequently identified by providers and community members as a problem in Central Oregon,
there is little recent data to estimate total burden of poor oral health in the region. Poor oral health
can cause pain, discomfort, and disfigurement; it can affect an individual's quality of life, ability to eat
and to speak, and can interfere with opportunities to learn, work, participate, engage and contribute.
What's more, poor oral health is related to chronic disease in later life.
6. Safety, Crime and Violence
Central Oregon counties have higher rates of abuse and neglect victims (confirmed cases) than the
state of Oregon. This may be due to differences in reporting and resources in the system of care, or an
actual higher rate of abuse/neglect. In 2009, Deschutes and Crook counties were ranked in the top ten
Oregon counties with highest crude rate of total violent crimes reported. In the same year, Jefferson
County was in the bottom ten Oregon counties for number of police per 1,000 of population. Last
year, more than 1,450 individuals in Central Oregon called an emergency crisis line about domestic
violence alone.
7. Chronic Disease
In the past 65 years, adult chronic disease has grown into the main health problem for industrialized
nations. Cardiovascular disease, cancers, diabetes and chronic obstructive pulmonary disease account
for at least 50% of the global mortality burden. In Central Oregon, chronic diseases are the leading
causes of death for each county. Crook County's age-adjusted prevalence of adults with high blood
pressure is 46.2%, significantly higher than 25.8% of adults for all of Oregon. Exposures, modifiable
behaviors, and risk factors all playa role in the development of chronic disease in later life.
8. Alcohol, Drug and Tobacco Use
In 2009, more than 19% of adult males reported binge drinking in the past 30 days. In Central Oregon,
adults age 18-25 years old report higher rates of alcohol dependence in the past 12 months than
individuals over 26 years old. Heavy drinking, drug use and tobacco use is associated with higher rates
of all-cause mortality, chronic disease, violence and abuse.
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9. Behavioral Health
In Deschutes County today, suicide claims nearly as many lives as motor vehicle accidents. It is
estimated more than 9,000 adults in the tri-county region have serious mental illness. Roughly 1/3 of
Central Oregon 11th graders reported having a depressive episode in the past year. High depression
scores are associated with poor academic achievement, anxiety, poor peer and teacher relationships.
The extent of the need for behavioral health services and the capacity to provide services should be
looked into. Early risk factors and prevention data also need to be investigated.
10. Healthy Environments
There is much to learn about the specific environmental health characteristics of Central Oregon's
communities. The ecological surroundings of individuals, families, communities and regions impact the
options available to individuals to reach their full potential for health. Environments-on any scale
simultaneously impact and are impacted by those within them. Built and natural environments directly
impact human health, and humans directly impact the built and natural environments.
Current and relevant data on all scales of environment is lacking in the Central Oregon region.
Locations of stores to purchase affordable fresh fruits and vegetables impact healthy choices. Safe and
affordable alternative commute options impact the behaviors of individuals to choose alternatives to
driving, thus impacting the environment. Safe and easily accessible places to play outdoors impact the
ability of children to play outside .
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