Message to the Community I am pleased to present the 2014-2019 Dakota County Community Health Improvement Plan. The plan is a combined effort by the Public Health Department and our many community partners. Special thanks to the Healthy Dakota Initiative steering committee for their excellent input and guidance. The Community Health Improvement Plan includes goals, measurable objectives and action steps for the two priority planning areas identified by the Healthy Dakota Initiative: promoting mental health and reducing obesity by increasing physical activity and improving eating habits. The plan is intended to be a call to action and a guide for community stakeholders to improving health in Dakota County. We look forward to working with you on implementing the plan to improve community health in Dakota County. Healthy regards, Bonnie Brueshoff Public Health Director, Dakota County Public Health Department About this report The Dakota County Community Health Improvement Plan is a key step in a long-term, systematic effort to address public health issues identified in the community health assessment. This report and the Dakota County Community Health Assessment are posted on the Dakota County website at: Dakota County Community Health Assessment For additional information, please contact the Dakota County Public Health Department by e-mail (Public.Health@co.dakota.mn.us) or by phone (651-554-6100). Original publication date: August 25, 2014 Dakota County Community Health Improvement Plan, 2014-2019
Table of Contents Executive Summary... 3 County Description... 4 Planning Process... 4 Document Format... 10 Priority 1: Physical Activity/Eating Habits/Obesity... 11 Priority 2: Mental Illnesses/Promoting Mental Health... 19 Definitions... 28 Dakota County Healthy Dakota Initiative Collaborating Organizations... 31 Acknowledgments... 30 References... 32 Appendix A Community Strengths... 35 Appendix B Forces of Change... 36 Appendix C Revision History... 39 Vision: Health and well-being for all in Dakota County Values: Strong community connections promote optimum well-being. Individuals, families, groups and organizations actively participate in creating a healthy community All who live or work in Dakota County regardless of age, gender, race, ethnicity, or socioeconomic status have multiple opportunities to maximize their health. Dakota County Community Health Improvement Plan, 2014-2019 2
Executive Summary The Healthy Dakota Initiative is a comprehensive community health assessment and improvement project initiated in April 2013. The Healthy Dakota Initiative Steering Committee includes representatives from a broad cross-section of partner organizations, including hospitals, clinics, schools, non-profits, and businesses, as well as community members from the Dakota County Human Services Advisory Committee (HSAC). The Healthy Dakota Initiative aims to engage the community in a strategic planning process to improve the health and safety of all Dakota County residents, and to ensure that the priorities and strategies are shared by the partners in the county. The Dakota County Community Health Assessment represented the first step in the planning process. In addition to information about the health of the community, the Community Health Assessment includes information about assets, challenges, barriers, and resources that the Healthy Dakota Initiative Steering Committee used to develop the Dakota County Community Health Improvement Plan (CHIP). Dakota County Public Health Department convened, facilitated and participated in the CHIP process. Based on the data from the Community Health Assessment, the Healthy Dakota Initiative Steering Committee identified two priority areas for the CHIP: Mental illnesses/promoting mental health Improve mental health and prevent mental illnesses by identifying needs, providing education, and promoting access to mental health services for all residents of Dakota County. Physical activity/eating habits/obesity Reduce chronic disease, health disparities, and health care costs by creating sustainable policy, system, and environmental changes that increase access to healthy food, increase opportunities to be physically active, and increase breastfeeding support. In addition, the committee decided to address healthy start for children and adolescents and health equity across both of these priority areas. Action teams of community partners were formed for the two priority areas to identify goals, measureable objectives and strategies. The action teams are committed to implementation, evaluation, and reporting to the community and stakeholders. Dakota County residents and community leaders are encouraged to use this plan as a resource and a call to action. Dakota County Community Health Improvement Plan, 2014-2019 3
County Description Dakota County is the third most populous county in Minnesota, comprising 7.5 percent of the population of Minnesota (1). It is located in the southeast corner of the Twin Cities Metropolitan area and encompasses 587 square miles, 562 square miles in land and 25 square miles in water (2). Two major rivers, the Mississippi and the Minnesota, form the county s northern and eastern borders. The county shares borders with the following counties: Hennepin County in the northwest, Scott County in the west, Rice County in the southwest, Ramsey County in the north, Washington County in the northeast, Pierce County, Wisconsin in the east, and Goodhue County in the southeast (3). Geographically, Dakota County is largely rural; however, the county maintains an equal land use mix of urban, suburban and rural (3). Nearly 80 percent of the county s population resides in the northern and northwestern portions of the county (4). Dakota County had an estimated 405,088 residents in 2012 (1). Dakota County is divided into 21 incorporated municipalities. A small portion of Hastings is in Washington County and the majority of Northfield is in Rice County (5). The five largest cities are: Eagan (64,206), Burnsville (60,306), Lakeville (55,954), Apple Valley (49,084), and Inver Grove Heights (33,880), which comprise 66 percent of the population of the county (4). Eagan is also the ninth largest city in Minnesota (6). Planning Process Process used by the Healthy Dakota Initiative The Healthy Dakota Initiative adapted components of the Mobilizing for Action through Partnerships and Planning (MAPP) model to collect data that was used to develop community health improvement strategies. MAPP is a strategic planning process used by communities to collect and analyze data, prioritize issues, identify resources to address priorities, and develop goals and strategies. It was jointly developed by the National Association of City and County Health Officials (NACCHO) and the Centers for Disease Control and Prevention (CDC) (7). Dakota County Community Health Improvement Plan, 2014-2019 4
Determining community health priorities The Healthy Dakota Initiative Steering Committee reviewed findings from the Community Health Assessment and considered input collected during the public comment period. The committee went through a multi-step process to identify priorities. In the first step, 12 priorities were evaluated on four dimensions: extent (e.g., groups at risk and number of people affected), seriousness (e.g., urgency of health problem, public concern, potential for long-term illness or disability, economic impact), gap in resources available (e.g., gaps or limitations in service or location of services, impact of lack of services on the community), and health disparities (e.g., differences in impact on various groups). As a result of that evaluation, ten issues were identified as top health priorities in Dakota County: Mental Illness: More than 26 percent of adults in the U.S. suffer from a mental disorder in any given year, with nearly six percent experiencing a severe mental illness. Mental health disorders are the leading cause of disability in the U.S. for 15-44 year olds (8). According to the U.S. Surgeon General, a range of effective treatments exist for most mental disorders, yet nearly half of all Americans who have a severe mental illness fail to seek treatment. Good mental health is essential to leading a healthy life. Physical activity/eating habits/obesity: Unhealthy eating, along with physical inactivity, is one of the most important risk factors for chronic disease in the United States. A study in 2000 estimated that 400,000 deaths annually could be attributed to poor diet and physical inactivity (9). Unhealthy eating, combined with physical inactivity, contributes to the development of obesity and chronic diseases, such as heart disease, stroke, type 2 diabetes, high blood pressure, osteoporosis and certain cancers. According to the Centers for Disease Control and Prevention, since the late 1970s, the prevalence of overweight and obesity in the United States has nearly doubled in adults, more than doubled in children and more than tripled in adolescents. Dakota County Community Health Improvement Plan, 2014-2019 5
Determining community health priorities (continued) Use of alcohol, tobacco, and other drugs: The misuse of alcohol and other drugs are important risk factors for chronic disease, death and disability in the United States. An estimated 79,000 deaths annually in the U.S. can be attributed to excessive alcohol use (10). Alcohol and illicit drug use are associated with unintentional injuries, violence, risky sexual behavior, and illegal behavior, and can lead to liver disease, cancer, heart disease, and neurological and psychiatric problems. Children exposed to alcohol or other drugs during pregnancy can suffer lifelong physical and mental disabilities. Use of alcohol or illicit drugs can lead to dependence in some people, which increases the risk of harmful consequences. Tobacco use is the single most preventable cause of disease, disability, and death in the United States, with an estimated 480,000 people dying each year from tobacco-related illness (11). Cigarette smoking is associated with cancer, emphysema, chronic bronchitis, heart disease, and stroke. In addition, there are health effects for non-smokers who are exposed to secondhand smoke, including an increased risk of dying from lung cancer or heart disease, and children are at increased risk of sudden infant death syndrome (SIDS), ear infections and asthma. Mothers who smoke cigarettes during pregnancy are at risk for poor birth outcomes, such as preterm birth, low birth weight, and stillbirth. Promoting mental health: According to the World Health Organization definition, mental health is... a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health is the basis for well-being and function of the individual and the community. Mental health, social conditions, and health behaviors may interact to intensify the effects on overall health of individuals. Public health funding: Adequate public health funding is necessary in order to maintain the infrastructure to keep the public healthy. Public health infrastructure refers to all aspects of the public health system that help health professionals carry out essential public health services to promote, protect and maintain the health of the community as a whole. Examples are: workforce capacity and competency, information and data systems, and organizational and systems capacity. It includes activities that are required by law, efforts to assure the delivery of public health services to diverse populations, and actions that help maintain the public health system. Dakota County Community Health Improvement Plan, 2014-2019 6
Determining community health priorities (continued) Preventing/management of chronic conditions: The leading causes of morbidity and mortality in Dakota County include preventable chronic diseases such as cancer, cardiovascular disease, stroke, and diabetes. In addition, the long course of illness for some chronic diseases results in activity limitations and pain, decreasing the quality of life for many county residents. Income/poverty/employment: The economic conditions in which people live and work can influence health and life expectancy. These conditions can affect a person s life and work conditions, such as stress levels, access to healthy food, safe places to exercise, exposure to environmental hazards, and availability of early learning opportunities. These exposures interact to increase or decrease the risk for many major diseases, such as heart disease, stroke and Type 2 diabetes. Healthy start for children and adolescents: The health of mothers, infants, and children is important for the health of the current generation and future generations. Healthy growth and development of infants depends on the health of the mother before conception and the health and safety of mother and infant during delivery. A positive, supportive environment for mother and infant following birth is also critical. Access to health care: Ability to access health care is affected by insurance coverage, cost, language and cultural barriers, availability of providers, and transportation. People who are not able to access health care are at increased risk for serious medical problems, premature mortality and poor health outcomes. Inability to access health care often results in receiving medical treatment later in the course of illness and in more costly settings, which increases the financial burden on the health care system. Affordable housing: Affordable housing is an important factor in both physical and mental health. Home ownership provides financial stability and control over the living environment. Home owners are more likely to be involved in the life of the community. Excessive housing costs limit the amount of funds available for other needs, such as food and medical care. It also results in elevated stress levels that have an impact on health. When housing is affordable, people do not have to move as frequently. Children who have a stable living environment have higher academic achievement and better health outcomes. Dakota County Community Health Improvement Plan, 2014-2019 7
The second step was to identify the priorities that would be incorporated into the Community Health Improvement Plan. To prepare for this step, the committee reviewed potential interventions from state and national frameworks, as well as an inventory of activities that were already occurring in the county related to the ten health concerns. The committee then evaluated the ten health priorities on three dimensions: seriousness of the problem, existence of effective interventions, and practicality of implementing the interventions. The evaluation produced two planning priorities: mental illnesses/promoting mental health and physical activity/eating habits/obesity. The committee also noted that two other highly-rated concerns, healthy start for children and adolescents and health equity, cut across both of the priority areas, and the group encouraged the action teams to develop strategies that address these issues. Action teams of community partners were formed to identify goals, measureable objectives and strategies for the two priority areas. The action teams will continue to be part of the implementation of the plan, and will regularly review progress, performance measures, and plan updates. Framework for community health improvement planning In developing the Dakota County Community Health Improvement Plan, the ideas from two frameworks were incorporated: 1) Healthy Minnesota 2020 and 2) Healthy People 2020. Healthy Minnesota 2020 is the statewide framework for improving health in Minnesota. Healthy People 2020 establishes 10-year, national benchmarks for improving health of all Americans. Both are based on the principle that health is the product of many factors, from individual biology to community and system health. These factors create the conditions that allow people to be healthy (12; 13). Dakota County Community Health Improvement Plan, 2014-2019 8
Implementation and monitoring of plan Below is the implementation timeline for the first year: September 2014 Present CHIP to Community Health Board Action teams develop work plans October 2014 Start CHIP implementation December 2015 Complete first annual report on CHIP Information will be collected on a quarterly basis in order to update the Dakota County Public Health tracking tool. The action teams have committed to developing annual work plans, and to meet at least twice per year to review the progress of each objective. At these meetings, community partners will give updates on their activities and discuss any barriers or changes that need to be made. Once a year, action team members will review progress and available measurement data on each objective. Based on this review, the action team may recommend quality improvement projects or revisions to the plan. Plan revisions will be decided by consensus of the appropriate action team and will be based on the following criteria: Feasibility of the strategy (if not started) Effectiveness of the strategy New or emerging health issue Strategy completed Change in health status indicators Change in level of resources available Note: The activities under the Obesity priority are funded by the Statewide Health Improvement Partnership grant, which is on a 2-year cycle. The interventions are prescribed by the grant and the work plan is set for the 2-year period, so the action team is not able to recommend plan revisions during the 2-year period of the grant. Therefore, annual discussions will be limited to progress on strategies, changes in level of resources, and recommendations for future grant cycles. An annual report will be completed by January of each year that details the progress and future plans for each of the objectives. Dakota County Community Health Improvement Plan, 2014-2019 9
Document Format This document is organized by the two priority areas: physical activity/eating habits/obesity and mental illnesses/promoting mental health. Each priority starts with vision and mission statements and a discussion of data from the 2013 Dakota County Community Assessment that supports the importance of this priority. The section for each priority includes several goals with objectives and strategies. Below are definitions of key terms used in these sections (14): Vision sets forth the ideal state that the community wants to achieve. It provides long-term direction and guidance for the community. Mission indicates how the community intends to achieve the vision. Values are beliefs or principles that the community members hold in common and strive to put into action. Goal is a fundamental issue the community needs to address. It is a desired end, which is not necessarily attainable or quantifiable. Objective is a measurable outcome that the community wants to achieve by focusing on the particular goal. Strategy is a broadly stated means of utilizing resources to achieve the goals. The strategies are understood to contribute to meeting the objective. Action plan is a document which includes tactics that describe who, what, when, where and how activities will take place to implement a strategy. Citations within the plan are designated by a number in parentheses, which corresponds to a numbered reference at the end of the document. Dakota County Community Health Improvement Plan, 2014-2019 10
Priority 1: Physical Activity/Eating Habits/Obesity Vision Improved health for residents, reduced incidence and prevalence of chronic disease, reduced health disparities, and reduced health care costs. Mission Create sustainable policy, system, and environmental changes to increase access to healthy food, increase opportunities to be physically active and increase breastfeeding support. The strategies for this portion of the plan are being implemented under the Statewide Health Improvement Program (SHIP) grant. SHIP is a program developed by the Minnesota Department of Health that employs evidence-based strategies for community-led improvements in healthy eating and physical activity (15). Why improving physical activity and eating habits is important Obesity is epidemic in the United States. Since the late 1970s, the prevalence of overweight and obesity in the United States has nearly doubled in adults, more than doubled in children and more than tripled in adolescents. Maintaining a healthy weight is an important part of overall health. Being overweight or obese increases the risk for many chronic conditions that can lead to disability and death, including high blood pressure, type 2 diabetes, heart disease, stroke, osteoarthritis and certain cancers. Lack of physical activity and unhealthy eating habits are the primary risk factors for becoming overweight or obese. Obesity affects all genders, ages, and racial and ethnic groups. In 2008, the Minnesota Department of Health estimated that medical expenses due to obesity were approximately $2.8 billion (16; 17; 18). In 2010, 60 percent of Dakota County adults reported height and weight that classified them as overweight or obese (34 percent overweight but not obese, 26 percent obese). This was below the statewide percent (63 percent), but exceeded the 2020 Minnesota target of 53 percent overweight or obese. The highest percent of overweight or obese was in persons aged 45-54. People with incomes at or below 200 percent of poverty also had a higher rate of being obese than the general population. In 2012, 11 percent of children ages 2-5 years enrolled in WIC were obese, compared to 13 percent statewide. The Healthy People 2020 goal is 9.6 percent for children in this age group. Statewide, American Indian children enrolled in WIC had the highest Dakota County Community Health Improvement Plan, 2014-2019 11
rate of obesity. Nineteen percent of Dakota County 8 th graders, 20 percent of 9 th graders and 20.5 percent of 11 th graders were overweight or obese in 2013. This was above the Healthy People 2020 goal of 16 percent for adolescents (19; 17; 20; 13; 21). Unhealthy eating and physical inactivity contribute to the development of obesity and chronic diseases, such as heart disease, stroke, type 2 diabetes, high blood pressure, osteoporosis and certain cancers. Unhealthy diets include too many calories, too much saturated fat and added sugar and sodium, and too few nutrients from not eating enough fruits and vegetables. Physical inactivity is one of the most important risk factors for chronic disease in the United States. Regular physical activity helps reduce the risk of heart disease, stroke, diabetes, and certain cancers; helps control weight; strengthens bones, muscles, and joints; prevents falls or helps reduce injuries from falls among older adults; and relieves anxiety and depression. People who live in communities that support active living are more likely to engage in physical activity as part of their daily routine, such as walking or biking for transportation. The percent of Dakota County students who were moderately physically active for 30 or more minutes on five of the last seven days slightly increased from 1998 to 2010 for all grades. In 2013, the percent of students getting at least 60 minutes of physical activity each day were: 19 percent (5 th graders), 20.5 percent (8 th graders), 21 percent (9 th graders) and 18 percent (11 th graders). Dakota County students in all grades, except 5 th grade, did slightly better than the state in 2013 (5 th graders: 21 percent, 8 th and 9 th graders: 20 percent, and 11 th graders: 17 percent). Hispanic and Asian students are less likely to meet the recommendation than White students. In 2010, 78 percent of Dakota County adults met the national recommendations of 150 minutes or more of moderate or vigorous activity per week, which is above the 2020 Minnesota target of 75 percent. Females, older people, those with less than a college education and those with incomes at 200 percent of poverty or less were less likely to meet the recommendation. Nationally, Blacks/African-Americans and Hispanics are less likely to meet the recommendation (19; 16; 17; 21). The percent of Dakota County students who ate five or more servings of fruits and vegetables the previous day stayed relatively stable for 6 th graders and slightly increased for 9 th and 12 th graders from 1998 to 2010. Sixth-graders had the highest percent; 12 th graders the lowest. 2010 percents: 21 percent (6 th graders), 20 percent (9 th graders), and 18 percent (12 th graders). Dakota County 6 th and 12 th graders did about the same as the state. Ninth graders did slightly better than the state percent (18 percent). The Healthy Minnesota 2020 target is 30 percent for all students. In 2010, 41 percent of adults reported eating five or more servings of fruits and vegetables the previous day. Males, people with less than a college education and people with incomes at 200 percent of poverty or less were less likely to have eaten five or more servings of Dakota County Community Health Improvement Plan, 2014-2019 12
fruits and vegetables. The Dakota County percent was better than the state percent in 2009 (22 percent) (22; 17; 19). Breast milk has immune-boosting and anti-inflammatory properties that decrease the risk of many childhood diseases. There is also evidence that breastfeeding decreases the risk of obesity and other chronic diseases, such as type 2 diabetes and asthma. In Minnesota, 73.5 percent of infants are ever breastfed, compared to 76.5 percent nationally. Forty-nine percent are breastfed at six months in Minnesota and nationally. Twenty-three percent are breastfed at 12 months, compared to 27 percent nationally. Minnesota is below the Healthy People 2020 goals: 81.9 percent ever breastfed, 60.6 breastfed at six months, and 31.1 at one year (23; 17; 13). Dakota County Community Health Improvement Plan, 2014-2019 13
Theory of change Short-term Medium-term Long-term More healthy foods and fewer unhealthy foods available at work, child care, school and in the community People have healthier eating habits throughout their lifespan Fewer people are overweight and obese throughout the lifespan Child care/preschools, worksites, and health care providers provide support to help mothers continue to breastfeed Mothers breastfeed for a longer duration Fewer people are overweight and obese throughout the lifespan More physical activity opportunities available at work, child care, school and in the community People are more physically active throughout their lifespan Fewer people are overweight and obese throughout the lifespan Health care providers will screen, counsel, and refer people with high body mass index (BMI) People with overweight and obesity are provided with opportunities to better manage their weight Fewer people are overweight and obese throughout the lifespan Cities make infrastructure changes to increase walkability and bikeability in the community Residents engage in active transportation methods throughout their lifespan Fewer people are overweight and obese throughout the lifespan Dakota County Community Health Improvement Plan, 2014-2019 14
Goal 1: Dakota County children and adolescents will have increased access to nutritious foods*, increased opportunities for physical activity and access to screening, counseling, and referral if at risk of developing chronic disease. OBJECTIVE Baseline Data source 1.1 By September 30, 2019, reduce the percent of preschool children who are obese to 10% (1% from baseline) (13) 11%: 2-5 year olds (2012) (24) Strategy Timeframe Partners 1.1.1 Child care/preschool programs will implement policy, systems, and/or environmental changes to increase access to healthy foods. (Focus: those serving lowincome and racially/ethnically diverse populations) WIC Pediatric Nutrition Surveillance System 2014-2019 Dakota County Public Health, child care providers/ preschool programs 1.1.2 Child care/preschool programs will implement policy, systems, and/or environmental changes to decrease access to unhealthy foods. (Focus: those serving lowincome and racially/ethnically diverse populations) 1.1.3 Child care/preschool programs and worksites will implement policy, systems, and/or environmental changes to support breastfeeding mothers. (Focus: those serving low-income and racially/ethnically diverse populations) 1.1.4 Child care/preschool programs implement policy, systems, and/or environmental changes to increase access to physical activity. (Focus: those serving lowincome and racially/ethnically diverse populations) 1.1.5 Strategy removed 1.1.6 Health care providers will screen, counsel and refer children and adolescents with high BMI. (Focus: those that serve a high proportion of patients who are uninsured or on Medical Assistance; racially/ethnically diverse patients; or infants/pregnant women) 2014-2019 Dakota County Public Health, child care providers/ preschool programs 2014-2019 Dakota County Public Health, child care providers/preschool programs, worksites 2014-2019 Dakota County Public Health, child care providers/preschool programs 2014-2015 Dakota County Public Health, health care providers Dakota County Community Health Improvement Plan, 2014-2019 15
OBJECTIVE Baseline Data source 1.2 By September 30, 2019, reduce the percent of children and adolescents who are obese to 7% (1% from baseline). 8% of 9 th graders (2013) (21) Minnesota Student Survey Strategy Timeframe Partners 1.2.1 School districts will implement policy, systems, and/or environmental changes to increase access and availability of fruits and vegetables. 1.2.2 School districts will implement policy, systems, and/or environmental changes to decrease access to foods high in sodium, saturated fat, and/or added sugar. 1.2.3 School districts will implement policy, systems, and/or environmental changes to increase access to physical activity before, during, and after school. 2014-2019 Dakota County Public Health, school districts 2014-2019 Dakota County Public Health, school districts 2014-2019 Dakota County Public Health, school districts Dakota County Community Health Improvement Plan, 2014-2019 16
Goal 2: Dakota County adults will have increased access to nutritious foods*, increased opportunities for physical activity and access to screening, counseling, and referral if at risk of developing chronic disease. OBJECTIVE Baseline Data source 2.1 By September 30, 2019, increase the percent of adults who are at a healthy weight to 47% (7% from baseline) (17). 36% (adults 25 and older) (2010) (25) Metro SHAPE Survey Strategy Timeframe Partners 2.1.1 Worksites will implement policy, systems, and/or environmental changes to increase access to healthy foods and decrease access to unhealthy foods in vending machines, catering, and on-site food services. (Focus: organizations that fit one or more of the following criteria: employ a diverse workforce, with more than 10% employees of color, have less than 200 employees, or have greater than 50% employees age 45 years or older) 2.1.2 Worksites will implement policy, systems, and/or environmental changes to increase opportunities for physical activity. (Focus: organizations that fit one or more of the following criteria: that employ a diverse workforce with more than 10% employees of color, have less than 200 employees, or have greater than 50% employees age 45 years or older) 2.1.3 Create a local food coalition to increase access to healthy foods and decrease access to unhealthy foods. (Focus: low-income, food insecure families) 2.1.4 Increase the number of farmers markets that accept EBT/SNAP/WIC. 2.1.5 Hospitals will direct community benefit programs to healthy eating, physical activity and chronic disease prevention. 2.1.6 Strategy removed 2.1.7 The county and cities will develop plans and systems and secure funding to improve walkability or bikeability in the community to increase active transportation among lowincome residents and residents age 60 years or older. 2014-2017 Dakota County Public Health, worksites 2014-2017 Dakota County Public Health, worksites 2014-2019 Farmers markets, food shelves 2014-2015 Farmers markets 2014-2015 Hospitals, Center for Community Health 2014-2019 Dakota County Physical Development, cities, Active Living Dakota County coalition Dakota County Community Health Improvement Plan, 2014-2019 17
2.1.8 Community agencies will increase offerings of evidencebased prevention services. (Focus: those in geographic areas that are low-income or diverse or who offer services to people age 60 years or older) 2.1.9 Work with mental health clinic to increase access to evidence-based prevention services, such as nutrition education and Diabetes Prevention Program 2014-2019 Dakota County Public Health, community agencies 2018-2019 Dakota County Public Health, mental health clinic Target outcomes are based on state or national goals (Healthy Minnesota 2020 (17) or Healthy People 2020 (13)), when available. If a state or national goal was not available for a particular measure, a goal was created by computing a 10 percent improvement over the baseline. *Increased access to nutritious foods includes: increased access to fruits and vegetables and reduced access to sodium, added sugar, and saturated fat. Dakota County Community Health Improvement Plan, 2014-2019 18
Priority 2: Mental Illnesses/Promoting Mental Health Vision Children, adolescents, adults and families in Dakota County have opportunities to attain optimal mental well-being. Mission Identify needs, provide education, reduce stigma, and promote access to mental health services. Values Partnerships exist between consumers, community and providers that promote mental well-being across the life span. Residents with mental illnesses have opportunity to achieve their full potential and to live in a community that is free of stigma and prejudice. Residents with mental illnesses actively participate in designing, protecting and strengthening their own mental health and well-being. Residents have the skills, supports and resources to manage and recover from life challenges that impact mental well-being. Why improving mental health is important Depression is a common but serious illness that requires treatment. Many individuals with clinical depression may require antidepressant medications. Depression interferes with a person s ability to work, sleep, and engage in daily activities. Depression can range from mild to severe, and severe cases may lead to self-injury and/or thoughts of suicide and suicidal actions. (Not all adolescents who engage in self-injury have severe depression). Emotional distress in adolescents can impair development and learning and interfere with sound decision-making. It can also lead to self-harm in adolescents, including cutting, suicide attempts, and suicide. An estimated six percent of Minnesota adults experienced significant depressive symptoms during the past year and four percent had symptoms suggestive of serious mental distress. Mental illnesses are a leading cause of disability in the United States. Socioeconomic factors and other social determinants of health, such as low income and poor educational attainment, are associated with poor mental health (26; 27; 28; 29). Dakota County Community Health Improvement Plan, 2014-2019 19
Another useful measure of mental health in the population is the average number of mentally unhealthy days. This measure is based on the self-reported number of days that mental health was not good in past 30 days. An average is computed for all persons who reported and it is age-adjusted to allow for comparison across different geographic regions. This measure can help characterize the burden of stress, depression, and emotional distress in a population. For the years 2006-2012, Dakota County residents reported an average of 2.5 mentally unhealthy days, below the state (2.6 days) and above the national (2.4 days) benchmarks (30). An estimated six percent of Minnesota adults 18 and older reported having at least one episode of major depression in 2012-13. The rates were highest among 18-25 year olds (nine percent). Minnesota is slightly above the Healthy People 2020 goal of 5.8 percent. More than onequarter of Dakota County students said that they had significant problems during the past year with feeling very trapped, lonely, sad, blue, depressed or hopeless about the future (2013: 24.5 percent of 8th graders, 28 percent of 9th graders, and 34 percent of 11th graders). Eighth and 9 th graders were below the state, but 11 th graders were above the state (32 percent) for 2013. Students of color were more likely to have had significant problems during the past year than White students. In the 2012-13 school year, four percent of students in Dakota County public schools were estimated by the school nurse to have depression or anxiety. This is a slight increase from two percent estimated in 2008-09 (21; 13; 31). Ultimately, mental illnesses can result in a person harming or killing themselves. Suicide is a serious public health problem with long-term consequences for individuals, families, and communities. Family members and friends who survive losing someone to suicide are often deeply impacted and are at increased risk for suicide themselves. Completed suicides are only part of the picture - more people survive suicide attempts than die. Suicide attempts can result in serious injuries that require costly medical care (32; 17). Suicide is one of the leading causes of death in Dakota County. For 15-24 year olds, it was the leading cause of death in 2012. For the period 2009-2011, the age-adjusted death rate for suicide in Dakota County (12.0 per 100,000) was above the statewide rate (11.5 per 100,000). The suicide rate increased by 35 percent from 2007 to 2010 (from 8.9 per 100,000 to 12.0 per 100,000), after several years of relative stability. It is above the Healthy People 2020 goal of 10.2 per 100,000. Males have a higher rate of suicide than females. During the period 2009-2011, the highest rate of suicide in Dakota County was in 45-54 year olds. Statewide, the highest rate of suicide is in American Indians (33; 34; 13; 17). Ninth graders are the most likely to have thought about killing themselves. In 2013, 14 percent of Dakota County 8 th graders, 15 percent of 9 th graders and 14 percent of 11 th graders had significant problems during the past year with thinking about ending their life or completing Dakota County Community Health Improvement Plan, 2014-2019 20
suicide. Eighth and 9 th graders were similar to the state, but 11 th graders were slightly above the state (13 percent) for 2013. In 2013, 3.5 percent of 8 th graders, four percent of ninthgraders and three percent of 11 th graders said they had attempted suicide during the past year. This is similar to the state. Students of color, with the exception of Asian students, are more likely to have had suicidal thoughts or attempted suicide than White students (21). Dakota County Community Health Improvement Plan, 2014-2019 21
Theory of change Short-term Medium-term Long-term Dakota County Healthy Communities Collaborative holds an annual mental health summit Community partners, including school-linked partners, refer youth to the appropriate community resources Fewer suicide attempts in youth Stigma associated with mental illnesses is reduced through public awareness People who have mental health concerns seek treatment and adhere to treatment Adults with mental illness experience a reduction in symptomatic days Primary care providers and schools screen and treat people for mental illnesses More people who have mental illnesses access resources and get needed treatment Fewer youth and adults delay getting needed mental health care People understand how to navigate the mental health system and what to expect More people who have mental illnesses access resources and get needed treatment Fewer youth and adults delay getting needed mental health care Mental health services are available that meet the needs of the community More people who have mental illnesses access resources and get needed treatment Fewer youth and adults delay getting needed mental health care Providers, faith communities, and community agencies are trained in youth mental health first aid Community members recognize mental illnesses and are able to assist youth in getting professional help Communities have the capacity to promote and protect mental health Dakota County Community Health Improvement Plan, 2014-2019 22
Goal 1: Community partners in Dakota County will adopt mental health promotion strategies that emphasize protective factors and self-sufficiency. OBJECTIVE Baseline Data source 1.1 By September 30, 2019, reduce the percent of youth who attempted suicide in the past year to 4% of 9 th graders Minnesota Student Survey 3% (1% from baseline). (2013) (21) Strategy Timeframe Partners 1.1.1 Continue to convene Dakota County Healthy Communities Collaborative (DCHCC) network, whose work includes organizing an annual Mental Health Summit. 1.1.2 Assist schools with implementing best practices for mental health promotion. 1.1.3 Partner with 1000 Petals to deliver a Moving and Learning Residency, providing a Yoga Calm Certified Instructor to train, consult, and provide follow-up support for teachers to integrate yoga-based movement into the school day with their students. (35) 2014-2019 Dakota County Healthy Communities Collaborative 2016-2019 Dakota County Public Health 2018-2019 Dakota County Public Health, 1000 Petals, school districts OBJECTIVE Baseline Data source 1.2 By September 30, 2019, reduce the average number of mentally unhealthy days for adults in the past 30 days to 2.3 days (10% improvement over baseline) (30). 2.6 days (2014) (30) County Health Rankings Strategy Timeframe Partners 1.2.1 Increase public awareness of positive mental health practices through social marketing campaigns and training, such as Make It OK, Ending the Silence, and Mental Health Awareness Month (May). (Primary target: low-income populations) 1.2.2 Strategy removed. 2014-2019 Dakota County Public Health, NAMI MN, Dakota County Social Services, Dakota County Community corrections, Dakota County Attorney s Office, Fairview Ridges Hospital, Center for Community Health, other trained partners Dakota County Community Health Improvement Plan, 2014-2019 23
Strategy Timeframe Partners 1.2.3 Organize an annual Living Longer: Power and Possibilities conference in the spring 2016-2019 Dakota County Healthy Communities Collaborative, Park Nicollet Foundation, Dakota County Public Health Dakota County Community Health Improvement Plan, 2014-2019 24
Goal 2: Community partners in Dakota County will assure access to appropriate services and programs that support optimal mental well-being. OBJECTIVE Baseline Data source 2.1 By September 30, 2019, reduce the percentage of adults who delay getting mental health care to 54% (2% from baseline). 56% (2014) (25) Metro SHAPE Survey Strategy Timeframe Partners 2.1.1 Strategy removed 2.1.2 Increase the understanding of the public and referral sources on how to navigate the mental health system, using a variety of media and methods. 2.1.3 Increase public awareness of positive mental health practices through social marketing campaigns and training, such as Make It OK, NAMI s Ending the Silence, and Mental Health Awareness Month (May). (Primary target: low-income populations) 2.1.4 Strategy removed 2.1.5 Ensure an adequate supply of mental health professionals to meet community needs by identifying data and strategies that demonstrate the need for additional psychiatrists in the county, and by promoting mental health careers in diverse populations. 2.1.6 Provide postvention consultations as needed after an event in a community 2014-2019 Dakota County Social Services and collaboratives, 2014-2019 Dakota County Public Health, NAMI MN, Dakota County Social Services, Dakota County Community corrections, Dakota County Attorney s Office, Fairview Ridges Hospital, Center for Community Health, other trained partners, school districts 2016-2019 NAMI MN, Dakota County Healthy Communities Collaborative 2016-2019 Dakota County Public Health OBJECTIVE Baseline Data source 2.2 By September 30, 2019, among youth who seriously considered or attempted suicide in the past 12 months, increase the percentage who received treatment during the past year to 32% (2.8% from baseline). 29% (8 th, 9 th, and 11 th graders) (21) Strategy Timeframe Partners 2.2.1 Engage school districts in identifying and referring students with mental health needs, including Minnesota Student Survey (composite measure developed by Dakota County Public Health) 2014-2019 Dakota County Social Services and collaboratives Dakota County Community Health Improvement Plan, 2014-2019 25
OBJECTIVE Baseline Data source coordination of school-based and school-linked services. Dakota County Community Health Improvement Plan, 2014-2019 26
Goal 3: Community partners in Dakota County will build local capacity and leadership that creates optimal mental well-being. OBJECTIVE Baseline Data source 3.1 By September 30, 2019, increase the readiness score of the community to engage in mental health promotion to 5 (one level from baseline). 4.1 (2015) Dakota County Mental Health Readiness Assessment (36) Strategy Timeframe Partners 3.1.1 Identify a community readiness tool and develop a baseline measurement. 3.1.2 Integrate mental health first aid in various settings within the county. 3.1.3 Increase public awareness of positive mental health practices through social marketing campaigns and training, such as Make It OK, NAMI s Ending the Silence, and Mental Health Awareness Month (May). (Primary target: low-income populations) 3.1.4 Continue to convene Dakota County Healthy Communities Collaborative (DCHCC) network, whose work includes organizing an annual Mental Health Summit. 3.1.5 Ensure an adequate supply of mental health professionals to meet community needs by identifying data and strategies that demonstrate the need for additional psychiatrists in the county, and by promoting mental health careers in diverse populations. 3.1.6 Convene a Suicide Prevention Conference and offer Means Restriction class to address the needs of middleaged men in Dakota County 2015 Dakota County Public Health 2014-2019 Dakota County Public Health, Fairview Ridges Hospital, NAMI 2014-2019 Dakota County Public Health, NAMI-MN, Dakota County Social Services, Dakota County Attorney s Office, Fairview Ridges Hospital, Park Nicollet, school districts 2014-2019 Dakota County Healthy Communities Collaborative 2016-2019 NAMI MN 2018-2019 Dakota County Healthy Communities Collaborative, Dakota County Public Health, NAMI, SA/VE Dakota County Community Health Improvement Plan, 2014-2019 27
Target outcomes are based on state or national goals (Healthy Minnesota 2020 (17) or Healthy People 2020 (13)), whenever available. If a state or national goal was not available for a particular measure, a goal was created by computing a 10 percent improvement over the baseline. Definitions Below are definitions for key terms used in this plan. (See also p. 6) Active transportation integrates physical activity into daily routines such as walking or biking to destinations such as work, grocery stores or parks (37). Bikeability indicates the extent to which people can get to where they want to go by bicycle. It includes such things as safety, distance to destinations, and surface conditions (38). Certified health care home: A health care home, or medical home, is an approach to health care in which primary care providers, families and patients work in partnership to improve health outcomes and quality of life, with an emphasis on care coordination. Minnesota has developed a process to certify health care homes based on measureable criteria, including patient tracking and registry and performance management and quality improvement. Certified health care homes are eligible to receive care coordination payments (39). Community health assessment is a systematic examination of the health status indicators for a given population that is used to identify key problems and assets in a community. The ultimate goal of a community health assessment is to develop strategies to address the community s health needs and identified issues (40). Community health improvement plan is a long-term, systematic effort to address public health problems on the basis of the results of community health assessment activities and the community health improvement process. This plan is used by health and other governmental education and human service agencies, in collaboration with community partners, to set priorities and coordinate and target resources (40). Community health improvement process involves an ongoing collaborative, community-wide effort to identify, analyze, and address health problems; assess applicable data; develop measurable health objectives and indicators; inventory community assets and resources; Dakota County Community Health Improvement Plan, 2014-2019 28
identify community perceptions; develop and implement coordinated strategies; identify accountable entities; and cultivate community ownership of the process (40). Community readiness is the degree to which a community is ready to take action on an issue (41). Ending the Silence is a 50-minute classroom presentation for middle school and high school students that raises awareness and changes perceptions around mental health conditions (42). Evidence-based prevention services are clinical recommendations for screening, counseling and other services that have been identified through scientific evidence reviews to be effective interventions to prevent chronic disease (43). Health equity occurs when every person has the opportunity to realize his/her health potential the highest level of health possible for that person without limits imposed by structures or systems of society, such as finance, housing, transportation, education, social opportunities, etc., that unfairly benefit one population over another (44). Healthy Minnesota 2020 is a framework for creating and improving health throughout the state of Minnesota, based on the statewide health assessment, that includes measureable targets for improvement (17). Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans (13). Local food coalitions aim to identify and propose solutions to improve local food systems; encourage local economic development; and increase consumer access to and the availability of affordable, healthy foods such as fruits and vegetables (45). Make It Ok is a social marketing campaign designed to reduce the stigma of mental illnesses by encouraging open conversations and providing education on the topic (46). Policy, systems and environmental change is an intervention that: creates or amends laws, ordinances, resolutions, mandates, regulations or rules; impacts all aspects of an organization, institution or system; or involves physical or material changes to the economic, social, or physical environment. It is designed to create and encourage healthy behaviors in communities (47). Dakota County Community Health Improvement Plan, 2014-2019 29