Creating Healthy Environments Audience Response Where We ... · • Health in Arizona Policy...

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Health and Wellness for all Arizonans

Creating Healthy Environments

Where We Live, Learn, Work

and Receive Care

Arizona Department of Health Services

Division of Public Health Services

Presenters:

Sherry Haskins, Health Policy Manager - Bureau of Health Systems Development

Anna Alonzo, Chronic Disease Office Chief - Bureau of Tobacco and Chronic Disease

Matthew Leversee, Healthy School Specialist - Bureau of Nutrition and Physical Activity


Audience Response

• Who is in our audience? Select the answer that most closely describes your work.

1. Academia2. Direct Service Provider3. Program Administrator


Objectives of Presentation:

• Increased knowledge of Policy, Systems, and Environmental (PSE) change

• Increased knowledge of how to integrate Behavioral Health and Public Health strategies

• Identify one PSE strategy that could be to utilized by your agency


To optimize the health of Arizona residents by

developing and strengthening systems services to

expand access to primary care and other services

with emphasis on the health needs of underserved

people and areas.

Mission of Health Systems Development

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Health and Wellness for all Arizonans Health and Wellness for all Arizonans

Core Functions

Primary Care Office for Arizona

Develop and implement strategies for strengthening primary care/health care delivery system

Administer programs to increase the number of providers/ improve services in underserved areas

Identify areas that need improved health services/assist with federal/state shortage designations

Provide TA to statewide partners


• Health in Arizona Policy Initiative (HAPI) utilizes evidence-

based approaches to address population health needs including

the:

– Health in All Policy Framework

– Health Impact Pyramid

– National Prevention Strategy

How can Behavioral Health be integrated into these evidence-

based approaches?

Health in Arizona Policy Initiative (HAPI)


What is Health in All Policies (HiAP)?

• It is a strategy to assist leaders and policymakers to integrate health, well-being and equity in the development, implementation, & evaluation of policies and services.

– Strategies are meant to ensure all policies and services from all sectors have beneficial or neutral impact on the determinants of health.

Source: Department of Health, Government of South Australia. (2010). Implementing Health in All Policies: Adelaid 2010. http://www.who.int/sdhconference/resources/implementinghiapadel-sahealth-100622.pdf

http://www.who.int/sdhconference/resources/implementinghiapadel-sahealth-100622.pdf

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Health in Arizona Policy Initiative (HAPI)

• Three year initiative funded through tobacco tax, state lottery

and federal Title V dollars.

• Focus Areas include Healthy Worksites, School Health,

Community Design / Healthy Communities, Clinical Care, &

Procurement


Why Worksites?


To help Arizona employers successfully implement

evidence-based healthy worksite initiatives to

improve the health of their employees and

businesses.

Purpose of the Healthy Arizona Worksites Program


• Reduce the risk of chronic disease among employees and their families through evidence-based workplace health interventions and best practices.

• Promote sustainable & replicable workplace health activities.

• Promote peer-to-peer healthy business mentoring.

Healthy Arizona Worksites Program Goals

http://www.healthyazworksites.org/




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Health and Wellness for all Arizonans13

• Arizona Department of Health

Services (ADHS)

• Maricopa County Department of

Public Health (MCDPH)

• Arizona Small Business Association

(ASBA)

Program Structure


HAWP Utilizes the CDC Worksite Health ScoreCard

A tool designed to help employers assess the extent to which they have implemented science-based health promotion interventions in their worksites to prevent heart disease, stroke, and related chronic conditions.


The CDC Worksite Health ScoreCard (HSC)

Tobacco control

Nutrition

Physical activity

Weight management

Stress management

Depression

High blood pressure

Assesses best practice health promotion interventions:

High cholesterol

Diabetes

Signs and symptoms of heart attack and stroke

Emergency response to heart attack and stroke

Organizational supports

New: Lactation Support, Immunization, Community Connectedness, Worksite Safety Culture


CDC ScoreCard – Behavioral Health Areas

Stress Management• In the past 12 months did your worksite:

o Provide dedicated space where employees can engage in relaxation activities, such as meditation, yoga, biofeedback?

o Sponsor or organize social events throughout the year?

o Provide stress management programs?

o Provide work-life balance/ life-skills programs?

o Provide training for managers on identifying and reducing workplace stress-related issues?

o Provide opportunities for employee participation in organizational decisions regarding workplace issues that affect job stress?



http://www.azdhs.gov/

http://www.azdhs.gov/

http://www.maricopa.gov/publichealth/

http://www.maricopa.gov/publichealth/

http://www.asba.com/

http://www.asba.com/

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CDC ScoreCard – Behavioral Health Areas

Depression• In the past 12 months did your worksite:

o Provide free or subsidized clinical screening for depression (beyond HRAs) followed-by directed feedback and clinical referral when appropriate?

o Provide access to online or paper self-assessment depression screening tools?

o Provide brochures, videos, posters, pamphlets, newsletters , or other written or online information that address depression?

o Provide a series of educational seminars, workshops, or classes on preventing and treating depression?

o Provide on-on-one or group lifestyle counseling for employees with depression?

o Provide training for managers on depression in the workplace?o Provide health insurance coverage with no or low out-of-pocket costs for

depression medications and mental health counseling?


Public Health in Action

• Collaborative initiative across the Division of Public Health Prevention

Services

• New 5 Year grant (Beginning June 29, 2013-Ending June 30, 2018)

• The CDC grant is a combination of two components: Basic (Non-

Competitive) and Enhanced (Competitive)

• Supports the implementation of targeted strategies resulting in

measureable impacts addressing School Health, Nutrition and Physical

Activity, Obesity, Diabetes, Heart Disease and Stroke Prevention



• Promote Collaboration and De-Siloing

• Promote Policy Systems and Environmental (PSE)

Change/Public Health Approaches

• Combines the former CDC Diabetes, Heart Disease,

Obesity and School Health funding

• Effectively and Efficiently Address the CDC Four

Domains


• The grant is guided by CDC’s Chronic Disease Prevention and Health

Promotion’s Four Domains:

Domain 1-Epidemiology & Surveillance

Domain 2-Environmental Approaches that Promote Health

Domain 3-Health Systems Intervention, and

Domain 4-Strategies to Improve Community-Clinical Linkages

• Budget for Year 1:

Basic Component $624,404

Enhanced Component $1,291,468

Total Grant: $1,915,872


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Audience Response

Policy, System and Environment (PSE) change

1. Refers to how funding is utilized.2. Is implemented to positively impact population health.3. Evaluates the health of the community.


• PHIA-Basic and Enhanced (School Health)

- Pilot program in Local Educational Agencies (LEA = school districts)

- Partner with Az Department of Education (ADE) Health and

Nutrition Team

• Empower model started in Early Childcare Education facilities-2010

“super-hero themed”

• Ten wellness standards for healthier youth and policies to address them

• Expansion

- Empower Plus

- Empower Home Visiting

- Empower Schools

Empower Schools


• Quick history of what school policies need to address:

• Wellness policy leadership

• Inclusion

• Nutrition promotion/education

• Physical Activity/Physical Education

• Other student wellness programming

• Food/beverage marketing

• Updates, assessment, public notice

• Oversight

Empower Schools


• Nine LEAs across seven counties through 2018

- ~38,000 students

• Creation of ten wellness standards, guidebook and policies

- “Empower Schools addresses physical activity and education, safety,

nutrition and health promotion in the school environment”

• Based off of CDC-Coordinated School Health Model

- (Health education, physical education, health/nutrition,

counseling/psychological, health promotion, community involvement)

Empower Schools

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• Unique PSE, early intervention and healthy behavioral improvement

approaches

- Sustainable

- Best practice

- Personal/parental accountability and involvement

• Creation of policies and connecting resources (de-silo)

- County health departments/hospitals

- Pediatrics/dentists/etc.

- Cooperative extension programs

- Behavioral/psychosocial services

Empower Schools


• Schools are in the business of creating a well-rounded student

- Look internally at resources (common mistake)

- Re-thinking resources available in community

• What’s not available and how to supplement it?

- Providing resources for each wellness standard

- Referral source (resources) provides opportunity for discussion

- Education to all staff and parents

Empower Schools


• Evaluation and Future

- Youth Risk Behavior Survey (YRBS) and Behavioral Risk

Factor Survey System (BRFSS)

- Staff/parent surveys

- Endorsement and expansion state-wide

- Best practice tool nationally

Empower Schools


Empower Schools

Takeaways from Empower Schools:

• School wellness policy improvement program geared to change health,

educational capacity and understanding/use of resources

• Five year pilot program with hope to expand on a large scale

• PSE project similar to the mandatory worksite wellness approaches in the

late 90s that are common today

• ROI driven and risk involved by investor

- Has ability to change how schools interact with community and

improve quality of life for some

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Audience Response

Empower Schools is focused on updating Wellness Policies.

1. True2. False


Audience Response

The opportunity to support local schools to improve health is available to

1. Academia2. Direct Service Providers3. Program Administrators4. All of the above


Chronic Disease Self Management Program (CDSMP) – Healthy Living

• Evidence-based self-management program developed by Dr. Kate Long at Stanford University (Stanford Model)

• Peer-led, community-based intervention that helps individuals with chronic conditions learn how to manage and improve their health

• Helps people with diverse medical and behavioral concerns develop the skills and coping strategies they need to manage their symptoms.



• Six week workshops are led by a pair of trained facilitators, many of whom have chronic health conditions. Approximately 10 – 15 participants

• 2.5 hour workshops using an established curriculum. Workshops are highly participative, with mutual success and support building participants’ confidence in their ability to manage their health and maintain active, fulfilling lives encouraged.

• Anyone with a chronic condition such as diabetes, arthritis, heart disease, asthma, or any other on-going health problem can participate.

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• Employs action planning, interactive learning, behavior modeling, problem-solving, decision making, and social support for change.

• Available – online or in-person, at community-based settings such as senior centers, churches, community health clinics and libraries

• Available in Spanish for the chronic disease and diabetes self-management programs

• Stanford-developed CDSMP trainer manual is available in over 19 different languages.


Cost EffectivenessBased on a review of major published studies, CDSMP results in significant, measurable improvements in the health and quality of life of people with chronic conditions.

Studies show CDSMP saves enough through reductions in health care expenditures to pay for itself within the first year.• Cost Savings

– $714 per person savings in emergency room visits and hospital utilization.

– $364 per person net savings after considering program costs of $350 per participant.

– Potential savings of $6.6 billion by reaching 10% of Americans with one or more chronic conditions.


Health Benefits• Improvement in exercise and ability to participate

in one’s own care over a two-year period.

• Improved health status in seven of nine variables:

– fatigue, shortness of breath, pain, social activity limitation, illness intrusiveness, depression, and health distress.

– Improved health behaviors in variables related to exercise, cognitive symptom management, communication with physicians, and self-efficacy.


Arizona• Arizona Living Well Institute

– https://alwi.org– 2066 W. Apache Trail, Suite 116

Apache Junction, AZ 85120Phone: 480-982-3118Toll Free: 877-982-3118Fax: 480-982-7320

– Master Training– Lay Leader Training– Workshops Scheduled

https://alwi.org/

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Counties Offering CDSMPCounty Program

Apache CDSMP

Coconino CDSMP

Cochise CDSMP/Tomando Su Control

Graham CDSMP

Greenlee CDSMP

La Paz CDSMP

Mohave CDSMP

Navajo CDSMP/Tomando Su Control

Pima CDSMP/Tomando Su Control

Yavapai CDSMP/Tomando Su Control

Yuma CDSMP/Tomando Su Control


Audience Response

Chronic Disease Self-Management Programs can be utilized by

1. University Employees2. Health Care Providers3. County Health departments4. All of the Above


Thank You

www.azdhs.gov/hsd

602-542-01219

Sherry Haskins, Health Policy Manager - [email protected] - Bureau of Health Systems Development

Anna Alonzo, Chronic Disease Office Chief - [email protected] - Bureau of Tobacco and Chronic Disease

Matthew Leversee, Healthy School Specialist – [email protected] - Bureau of Nutrition and Physical Activity

http://www.azdhs.gov/hsd

mailto:[email protected]



Creating Healthy Environments Audience Response Where We ... · • Health in Arizona Policy...

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