Community Health Needs Assessment. Implementation Strategy.. SAMPLE TEMPLATE

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1 Community Health Needs Assessment & Implementation Strategy SAMPLE TABLE OF CONTENTS Executive Summary I. Service Area and Population II. Community Health Needs Assessment Partners.. III. IV. Community Health Needs Assessment Methodology and Process. Identified Community Needs.. A. Needs Identified B. Process for Prioritizing C. Prioritized Needs V. Community Resources to Address Needs A. Internal Hospital Resources B. External Community-Based Resources. VI. Implementation Strategy.. A. How Hospital Will Address Health Needs. 1. Community Health Logic Model B. Needs Not Addressed in Plan..... Appendix I. Service Area Census Data... Appendix II. Key Stakeholder Interview Summary... Appendix III. Service Area Survey Results. Appendix IV. Community Involvement in CHNA. References

2 EXECUTIVE SUMMARY Background and Process Who did what, with data from where. The final approved version of the CHNA and Implementation Plan is available to the public on the hospital website. Needs Identified ADULTS (Source: ) Indicator Community Community Community County State National Overweight & Obese High BP, Cholesterol 1 poor MH day/mo. Lost 1 tooth to decay 2yr since dr. visit Lack health, dental ins. Binge drank, past month Tobacco, current users Illegal drug use 5 fruit/vegetables daily No physical activity Gets social support CHILDREN and TEENS (Source: ) Indicator Community Community Community County State National Overweight & Obese Depressed in past yr. Binge drank, past month Tobacco, ever used Marijuana, ever used Misused rx, rx painkiller 5 fruit/vegetables daily 60 min. PA most days Witnessed bullying Key: BP Blood Pressure, Ins. Insurance, MH Mental Health, NA Not Available Prioritized Needs What the top priority needs are, and how that was determined. Implementation Plan Strategies hospital will use to impact needs identified, including collaboration with local partners. 1

3 I. Service Area and Population Define hospital service area geographic boundaries, population size, demographic information. TABLE 1. Service Area Population Demographic Data EDUCATION Less than high school High school Some college College graduate INCOME Less than $35,000 per year $35,000 - $74,999 per year More than $75,000 per year MILITARY STATUS Yes, active duty ever Never served in military EMPLOYEMENT STATUS Employed for wages Self-employed Out of work Homemaker Student Retired Unable to work DISABILITY Disabled Not disabled Source: Service Area County or State II. Community Health Needs Assessment Partners Identify and explain roles and responsibilities of internal contributors to the process, and external partners in the process III. Community Health Needs Assessment Methodology and Process Explain methodology of key data sources, including surveys, focus groups, stakeholder interviews, or others. Explain any gaps in the data. 2

4 IV. Community Health Needs Identified in Assessment Explain needs identified, include data sources and key statistics (graphs as appropriate). Explain the process for prioritizing List prioritized needs V. Community Resources to Address Needs Hospital internal resources External, community-based resources VI. Implementation Strategy Explain how the hospital will engage community partners to implement strategies to address needs Insert Logic Model, or other planning tool that outlines what strategies will be implemented to address needs. Explain which needs will not be addressed with strategies and activities, and why. 3

5 SAMPLE COMMUNITY HEALTH LOGIC MODEL Problem Statement Strategies Activities Outcomes Problem Why? How? Specific Actions Intermediate Long-term Obesity - Majority of adults and more than 1/3 of youth are overweight or obese Poor nutrition due to limited access, high cost of fresh fruits and vegetables and healthy proteins, and low motivation to change Change incentives for consuming healthy foods at the hospital to promote healthy choices Increase consumption of fruits and vegetables Lack of physical activity due to lack of access to pedestrian paths and affordable facilities, sedentary work environments, and low motivation to change Change incentives for consuming healthy foods at the hospital to promote healthy choices Enhance access to programs that promote physical activity and provide support to sedentary adults Decrease consumption of soda or sweetened beverages Increase the % of adults engaging in weekly moderate and vigorous physical activity. Decrease average daily screen time Decrease the % of adults and youth that are overweight or obese (BMI > 25) Heart Disease & Stroke - More than 1 in 5 adults has high blood pressure and/or high cholesterol Substance Abuse Binge drinking, drunk driving, and tobacco use are high compared to neighboring communities Tobacco use, due to access, lack of quit resources Lack of access to care, due to income, lack of insurance Binge drinking & drunk driving, due to lack of knowledge, enforcement of alcohol laws Enhance access and skills, and provide support to smokers who want to quit Change policies to limit exposure to secondhand smoke Enhance access to blood pressure screening Enhance skills of employees at businesses that sell alcohol Enhance enforcement of alcohol laws, including driving under the influence Reduce the % of adults who smoke. Increase the % of adults who have seen a doctor in the past year Increase # of drunk driving checkpoints. Increase % of retailers in responsible server training Decrease the % of people who have high blood pressure or cholesterol, and those who have ever had a stroke or heart attack Decrease the % of adults who binge drink, drive drunk, or use tobacco. 4

6 Appendix I. Census Data Appendix II. Key Stakeholder Interview Summary Appendix III. Survey Data Tables Appendix IV. CHNA Partners First Name Last Name Credentials Organization 5