Collinsville, Oklahoma
July 28, 2009
Miscellaneous News

Health Improvement Plan For Review /
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Attached (below) is a first draft of our County Health Improvement Plan. This is the culmination of 2 years of work from our staff, partner agencies and community residents. Today marks the first day of the public comment period, and the plan is in need of continued feedback and improvement before a final copy is submitted for approval to the Pathways to Health Partnership.

Please take some time to review the plan and add to, edit and/or remove interventions that are listed in the templates and other areas of the plan. This is a dynamic document and requires the collaborative feedback and input of each one of you. You will see that parts of the plan are still missing information, particular areas in the templates entitles “Key Contacts” and intervention strategies related to “Safe Housing” and “Access to Health Care”.

We are depending on the feedback of our community to complete this guide so that we can move towards implementation. We thank you for your constructive criticism and suggestions. Please feel free to send comments directly to Alicia Plati or go to the website after 12pm today (www.pathwaystohealthtulsa.org) and comment directly on the blog for your region. Comments will be accepted through Monday, August 3rd.”

Thanks!

Alicia Plati, MPH
Program Development Coordinator
Tulsa Health Department
Executive Director, Community Hospitals Authority
Office: (918) 595-4058
Mobile: (918) 850-3509
Fax: (918) 595-4037

Visit our community blog at:

www.pathwaystohealthtulsa.org!

(see draft plan at bottom of this page)

July 2009 Draft -- Tulsa County -- Community Health Improvement Plan

EXECUTIVE SUMMARY

We are excited to present to you our Community Health Improvement Plan (CHIP), a combined effort of the Pathways to Health Partnership. Pathways to Health Partners are leaders of public, private, non-profit and other organizations throughout Tulsa County.

Each agency represented in the partnership has a vital role to play in improving the health of Tulsa County residents. The role of the partnership is to provide members of the community with an organized forum to address their health needs.

Pathways to Health began in 2007 with the completion of the Tulsa County Health Profile, the first of four assessments to be completed over the past two years. Partners gathered in June of 2008 for the Governance Assessment, the second, to assess the current status of our Public Health System.

In July of 2008, Tulsa County was divided into 6 regions based on public school district boundaries. From August 2008 through April 2009 the community completed two additional assessments to identify forces of change and strengths and themes for their regions. Community input was gathered through a variety of efforts including town hall meetings, focus groups, surveys (online and in-person) and blogs.

What follows is more than just a plan-it is a guide for community members and agency leaders alike. For community members, this guide will help you to identify the agencies and parties responsible for implementing policies and programs that influence the health issues most important to you. For agency leaders, this guide will help you as you move through strategic planning processes to ensure you are utilzing your resources to most appropriately meet the needs of the community you serve.

We are appreciative of the time Community Health Ambassadors and partnership agencies have given for the citizens of Tulsa County. This guide is the first step towards a collaborative effort at improving health for all.

Sincerely,

Gary Cox
Director
Tulsa Health Department
Table of Contents


The Players
Members of the Pathways to Health Partnership……………………………4

The Foundation
Tulsa County Regions………………………………………………………….5
Mobilizing for Action Through Planning and Partnerships (MAPP) 101.....6
The Assessments………………………………………………………………7

The Building Blocks: Tulsa County Demographics and Health Trends
Trends and Statistics……………………………………………

The Blueprint: Community Identified Public Health Priorities

Laying the First Block: How You Can Help
Community Residents……………………………………………………….
Agency Leaders………………………………………………………………


The Players

The Pathways to Health Partnership was formed in May 2008. A cross-section of agencies throughout Tulsa County was invited to participate in a one-day retreat in June 2008 that included small group discussion and dialogue about the Tulsa County Public Health System. Agencies represented included:

Community Action Project, City of Broken Arrow
George Kaiser Family Foundation, Morton Health Center
Indian Health Care Resource Center, Oklahoma House of Representatives
School Superintendents, LIFE Sr. Services
YMCA, NAACP
St. Johns Medical Center, Metropolitan Tulsa Transit Authority
Tulsa Health Department, Goodwill Industries
OU School of Medicine, INCOG
Oklahoma Turning Point, Richard Wheatley Co, Inc
Tulsa Community Foundation, City of Owasso
Community Service Council, Tulsa County
Morningside Foundation, Tulsa Community College
Greenwood Chamber, OSU School of Medicine
Tulsa County Medical Society, City of Tulsa
Tulsa Housing Authority, Family & Children’s Services
Tulsa Fire Department, Hispanic Chamber
Langston University, Tulsa Metropolitan Ministries
Tulsa Jewish Retirement and Health Care Center, Tulsa Police Department
Planned Parenthood, YWCA
Office of the Governor, St. Francis Medical Center
DHS Board American, Red Cross
Parks Department, Community Health Connection
Tulsa Technology Center, Richard Wheatley Co, Inc
City of Collinsville, City of Owasso


The Foundation

Community feedback was aggregated based on the regions below. The health issues discussed in this guide are issues affecting all of the regions. You can view all of the original issues by region at: www.pathwaystohealthtulsa.org/blogs.


Mobilizing for Action through Planning and Partnership
The Basics of MAPP

MAPP is a strategic tool that local health departments across the country have utilized to help direct their strategic planning. This tool, implemented here in Tulsa County, helps communities improve health outcomes by developing non-traditional partnerships through community-wide collaboration.



Pathways to Health uses the MAPP model shown in the center of this page. This model was developed by the National Association of County and City Health Officials (NACCHO) in cooperation with the Public Health Practice Program Office, Centers for Disease Control and Prevention (CDC). A work group of local health officials, CDC representatives, community representatives, and academicians developed MAPP from 1997 through 2000.

As illustrated, MAPP is broken up into four distinct assessments that are the foundation of the planning process. In addition, MAPP includes identifying strategic issues and formulating goals and strategies prior to taking action.

The residents of Tulsa County were tasked with identifying the strategic health issues for their region. As the facilitator, the Tulsa Health Department then identified universal issues that each region shared and presented these back to the community.

The four distinct MAPP assessments are the foundation for understanding how our community functions right now and identify the areas in need of improvement and growth. You can see below how each assessment is crucial to the development of this guide.

Community Themes & Strengths Assessment was utilized to better understand the sources of community pride and how residents view their community.

Local Public Health System Assessment was an opportunity for all members of the Tulsa County Public Health System to take an candid look at how services are delivered and the existing capacity to meet community needs.

Community Health Status Assessment was completed first and helped to identify major health concerns and issues within the community.

Forces of Change Assessment focused on areas such as the physical environment, policies and legislation that help or prevent residents from living healthy lives.
The Assessments

Community Health Status Assessment

This assessment was completed in early 2007 and is rich with data regarding health outcomes and demographic information for the residents of Tulsa County. Tulsa Health Department staff worked over the course of a year to gather and develop the information necessary to paint a clear picture of the health status for Tulsa County residents. The results from this assessment confirmed the need to implement the MAPP process in Tulsa County.

Local Public Health System Assessment

With the help of the consultant group Milne & Associates, the Tulsa Health Department convened partners from across the county to participate in an assessment of our Public Health System. This included a rigorous day-long event to complete the National Public Health Performance Standards evaluation of the 10 Essential Services of Public Health for Tulsa County. It was important to the mission of Pathways to Health that broad stakeholder representation, as well as elected government officials, were part of this process. The Pathways to Health partners used this assessment to develop a charter that included a mission, vision, and values. This charter helps solidify each agency and individual’s commitment to implementing the MAPP process and utilizing the results to develop a comprehensive health improvement plan.

Community Themes & Strengths and Forces of Change Assessments

These assessments were completed together because they both evaluate community perceptions and reactions to the quality of life for Tulsa County citizens. Using a six question template, staff from the Tulsa Health Department fanned out across Tulsa County to collect feedback from both community groups and individuals. The questions were intentionally open ended, allowing groups to come to consensus about responses. All participants were asked the same questions:

What are some of your community successes?
Can you identify sources of pride for your community?
What do you worry about? For yourself, your family or your friends.
If you could change anything about your community, what would it be and why?
When you have a need, health related or otherwise, who do you turn to?
Are there specific obstacles in your community and life that prevent you from living a healthy lifestyle?
The Building Blocks: Tulsa County Demographics and Health Trends

In every planning process, there must be a starting point-for Pathways to Health, that starting point was the data. A planning group comprised of the Community Service Council, the City of Tulsa, the Indian Nations Council of Governments (INCOG), and the Tulsa Health Department worked together to analyze the Tulsa County Health Profile data and develop regional county health status information that could be pulled into presentations for each community.

The data collected was analyzed at the zip code level and included, but was not limited to:
v1 Birth and death rates
County population and demographics
Mortality data
Incidence of teen births
Female-headed households
Violence indicators
Incidence of communicable diseases (STDs and HIV/AIDS)
ER utilization
Rates of Medicaid use
Rates of uninsured

This data was compared to both state and national rates in order to illustrate how healthy Tulsa County is in comparison.

The planning group identified some specific and measurable health outcome goals in order to ensure that action plans developed for the community’s strategic issues could be evaluated. These goals, or metrics, can be broken down into three categories: age-adjusted death rates, birth indicators and access to healthcare. Please go to www.pathwaystohealthtulsa.org to view the exact rates for each region as well as the entire county, state and national rates.

Demographics: Who is Tulsa County?

According to the 2005 - 2007 American Community Survey, Tulsa County is home to 577,727 individuals. A diverse county located in the Northeast corner of Oklahoma, Tulsa County is home to 26% minorities, the largest group being African-Americans. There has also been tremendous growth among the Hispanic/Latino population, currently 8.9% of Tulsa County.

The median age of Tulsa County residents is 35.7 years, with nearly three-fourths of the population between the ages of 18 and 64 years of age. This is a tremendous strength of the community, indicating that we have a large proportion of our population able to work. The average Oklahoma and Tulsa County incomes fall below the national average, and vary tremendously by race. These income differences are of great concern due to the impact they have on health outcome disparities in the community.
The Blueprint: Community Identified Health Priorities

Where do we go from here?

There is a saying that goes something like this: If you don’t know where you’re going…pretty much any road will get you there.

Improving health outcomes for our community will require that we, as a partnership of diverse public health agencies and community residents, decide which pathways are going to lead to a healthier community.

When identifying the health priorities for Tulsa County, much attention was paid to incorporating and assessing health issues from a variety of angles. We did not take health issues and look at them as independent of the other areas impacting our community such as employment, education, and poverty, rather, each interaction we had with community members reinforced that how we address health priorities will have to be multi-faceted.

The result, this guide, is a compilation of evidenced based practices that have been proven to impact health outcomes along side the ideas of YOU, the community, that we hope to impact. Throughout the course of this multi-year process, every effort was made to maintain open lines of communication to ensure community input and feedback. Blogs, e-mail distributions, coalition meetings and neighborhood associations all helped to make this guide a COMMUNITY guide to health improvement.

The templates that follow will help outline some of the interventions that have been identified as effective by community residents and health professionals alike. Each of the contributing agencies has a wealth of programs available to assist residents in addressing the issues selected, but the interventions included below are ones that have not been implemented yet, and will take a continued collaborative effort to do so.

Remember, this is your plan, your guide, your pathway, to a healthier you, a healthier family, and a healthier community!
The obesity epidemic that has emerged aggressively in the teen and child populations is an increasingly alarming health concern. During these ages children and teens are developing behavior patterns that will follow them into adulthood. It is crucial to begin prevention practices as early as possible in order for our youth to develop a comprehensive understanding of the importance of proper nutrition and regular physical activity.

ISSUE CHILDHOOD AND ADOLESCENT OBESITY
Goal Decrease the prevalence of childhood and adolescent obesity Outcome Objectives/Indicators §1 Decrease the percentage of the adult population in Tulsa County reporting no physical activity by 10% by January 2013 (From 25.9% in 2006 to 23.3%) §2 Determine and reduce the percentage of at risk children and adolescent in the 85 (children) and 89 (adolescent) BMI percentile by 10% by January 2013 §1 Determine and reduce the percentage of children and teens above a BMI classification in the 95th percentile by 5% by January 2013 (Reported by OK2Share, 2007 rate is 15.2%) §3 Determine and increase the population of school-aged children eating breakfast by 10% (determine by January 2010 increase by May 2013) §4 Determine and increase participation of Tulsa community members enrolled in physical activity facilities such as YMCA by 10% (determine by December 2010 increase by December 2012) §5 Implement mentoring program in every school district by August 2011
Risk Factors Unhealthy diet Meal patterns Lack of physical activity Low income family Minority group member Family history Impact Objectives Provide safe environments for physical activity Increase the amount of physical activity opportunities
Direct Contributing Factors Lack of education Lack of positive role models Large portion sizes Poverty Depression Indirect Contributing Factors T.V. , computers, gaming systems Lack of access to healthy foods Bullying Unsafe streets Incomplete sidewalks/bike lanes Suggested Intervention Strategies §1 Adopt-a-Participant o Members of local physical activity facilities can sponsor membership for low-income youth and elderly o Facilities work with are middle schools, high schools and senior housing complexes to identify individuals who may benefit from membership o As facility members offer/agree to sponsor a membership, individuals identified are notified by the facility that their gym membership fees have been waived o Sponsored members must utilize the facility at a minimum 4 visits/week in order to maintain membership status §2 Park Rangers o Partner with local area high schools, Police Academy trainees and the American Red Cross to provide volunteer high school student park rangers during after school hours o Rangers will not be subject to any supervision ratios, but will provide basic surveillance at local parks to help parents encourage after school activities o All rangers will be trained in basic First Aid and CPR and establish consistent and regular volunteer hours §3 Farmer’s Market Breakfast Programs o Partner local farmer’s markets with area elementary schools o Rotate farmer’s markets so that each elementary school has a farmer’s market breakfast at least 1 day/school week §4 Me 2 U o Require area high school and college students to complete a set number of community service hours o Provide mentoring opportunities to satisfy community service hours o Implement college/high school, high school/middle school and middle school/elementary school mentor/mentee programs o Encourage use of e-mail, text and other forms of communication for consistent interaction and reinforcement of improved self-esteem §5 Health2Health o Partner with local grocers to set up health kiosks throughout the stores o Promote healthy shopping by providing health/nutrition professionals at local supermarkets as a resource to provide cooking demonstrations at regular and consistent times. These professionals would also distribute healthy and easy recipe information. §6 Walking School Bus o Local elementary and middle schools partner with assigned police divisions and patrol officers to walk to school with neighborhood kids and/or have all elementary and middle school kids bussed to central location approximately 1 mile from school grounds and have teachers meet students at location to walk to and from school as a class
Resources Available County parks Community Centers Sports Fields/ Courts YMCA: sliding scale dues YWCA adjusted rates Ok. Fit Kid Coalition It’s All About Kids In school Physical Education After School Programs Mentoring Programs (Big Brothers/ Big Sisters) Mayors Million Mile Challenge Fix Our Streets PlaniTulsa Parks and Recreation Department Oklahoma AfterSchool Association All Star Sports Complex Dog Parks Oxley Nature Center Key Contacts Susan Neal (oversees the Park Department) Dale McNamara (Tulsa Park board chairwoman) Keith Ballard (superintendent TPS) Youth Sports Staff Parents of school age children Youth Mentors (H.S. and College) Parks and Recreation Staff Police Officers of high crime districts Police Chief Ronald Palmer Public Service Company of Oklahoma

Living in a society with an ever growing fast food industry it is important for our community to realize the impact of unhealthy food selection. Making health conscious food choices sets an example for our youth and provides our bodies with the fuel necessary to support all body functions from our skeletal system to our immune system.

ISSUE NUTRITIONAL ACCESS
Goal Improve affordability and availability of nutritional foods Outcome Objectives/Indicators §1 Increase percentage of adults in Tulsa County consuming five or more servings of fruits and vegetables daily from 15.4% (BRFSS, 2007) to 25% by May 2014 §2 Have at least 40% of Tulsa County SNAP recipients utilize farmers markets by 2011 §3 Ensure that there is a grocery store or farmer’s market within 1.5 miles of every Tulsa County resident by December 2015 §4 Increase participation in Farm-to-School Initiative to include every school district in Tulsa County, ordering at least 1 fruit or 1 vegetable per meal by August 2013 §5 Ban junk food from all vending machines in schools within Tulsa County by August 2013 §6 Double the number of school gardens within Tulsa County by May 2012 §7 Double the number of community gardens within Tulsa County by May 2014
Risk Factors Low income Lack of nutrition education Impact Objectives Improve affordability of nutritional foods Improve availability of nutritional foods Improve nutritional education availability
Direct Contributing Factors Poverty Lack of knowledge Lack of time Indirect Contributing Factors Limited transit options No supermarket in close proximity Abundance of inexpensive fast food Suggested Intervention Strategies §1 Double SNAP o Establish a list of healthy food options o Provide SNAP participants with the healthy food options list and double vouchers used towards foods on “Healthy Options List” o Partner with WIC to educate SNAP participants on double vouchers and Healthy Options List o Partner with local farmer’s markets to ensure SNAP participants can obtain food on the “Healthy Options List” through this avenue §2 Create economic stimulus programs and public-private partnerships to promote the creation of farmers’ markets and the expansion of retail grocery operations in low-income neighborhoods §3 Farm-to-School o Partner with local philanthropy groups to provide school supplies to local schools utilizing Farm-to-School o Target Title 10 schools o Develop Farm-to-School take home bags for parents to purchase at low-cost on Fridays to continue healthy eating at home §4 Take the “F” out of Fat! o Remove all deep fryers from school cafeterias o Require school cafeterias to incorporate 1 fruit or vegetable from the Farm-to-School program in every meal served o Have a “bring your parents to lunch day” and develop relationships with parents’ businesses to help support more parental involvement in the school day §5 Start/expand school and community garden programs that provide produce for school cafeterias allowing children to grow and eat their own foods and learn firsthand about nutrition
Resources Available SNAP Local farmer’s markets Farm-to-School Initiative Oklahoma Food Policy Council Kerr Center Oklahoma Department of Agriculture, Food, and Forestry (ODAFF) State Department of Education Local school districts Regional Food Bank of Oklahoma Tulsa Community Garden Association Sustainable Tulsa Mayor’s Green Team Key Contacts

Safe housing is the basis for healthy living. Without affordable opportunities to healthy housing facilities our community will lack the support necessary to thrive to its full potential. We need to ensure that every community member from young to old has the opportunity to obtain and sustain a secure foundation for themselves and their families.

ISSUE SAFE, AFFORDABLE, AND HEALTHY HOUSING
Goal Provide safe, affordable, and healthy housing for Tulsa residents Outcome Objectives/Indicators §1 End chronic homelessness in Tulsa County by 2012 §2 Decrease number of landlord complaints in Tulsa County by 10% by 2013 §3 Identify at least 10 local organizations to commit to quarterly community clean up days by 2011 §4 Enact policy that requires sidewalks with all new development in Tulsa County by 2012 §5 Evaluate street light conditions in at-risk zip codes (defined as a an average overall risk/outcome rating of 3.5 or worse in the Tulsa County Health Profile) by December 2011 §6 Enact policy that requires street lights with all new development in Tulsa County by 2012 §7 Increase the number of active neighborhood watch groups by 20% by 2013 §1 Increase the number of registered homeowner’s associations by 20% by 2013
Risk Factors Low income Unemployment Mental illness Substance abuse Divorce In an abusive relationship Transitioning out of institutionalized care Single-parent family Lack of family support Physical disability Impact Objectives Address absentee landlords Improve neighborhood pride Decrease homelessness in the community Increase community involvement in ensuring safe, affordable, and healthy housing
Direct Contributing Factors Poverty Family history of mental illness Lack of illness Economic downturn Indirect Contributing Factors High cost of housing including rental housing Economic downturn Lack of adequate public assistance Lack of mental illness treatment Suggested Intervention Strategies §1 Partner with Environmental Health Department of Tulsa City-County Health Department and The Housing Authority of the City of Tulsa regarding landlord complaints and home inspections to work more efficiently §2 Utilize community involvement to clean neighborhoods and parks of trash and graffiti §3 Mandate sidewalks with all new development §4 Mandate street lamps with all new development §5 Create new neighborhood watch groups in addition to increasing participation in existing neighborhood watch groups §6 Increase coordination among organizations and services working with Building Tulsa, Building Lives §7 Create new homeowner’s associations in addition to increasing participation in existing homeowner’s association
Resources Available Neighborhood Inspections, a section of Working in Neighborhoods (WIN) Working in Neighborhoods (WIN) Housing Authority of the City of Tulsa Environmental Health Services of Tulsa Health Department Mayor’s Action Center Local organizations City of Tulsa: Planning Commission-Tulsa Metro Area City of Tulsa Public Works Department-Development Services City of Tulsa Planning Department Building Tulsa, Building Lives Mayor Kathy Taylors Task Force to End Chronic Homelessness (Tulsa Strategic Plan to End Chronic Homelessness by 2012) Tulsa County Sheriff’s Office Tulsa Police Department Tulsa Metro Chamber Key Contacts

Mental health and substance abuse are complicated and interwoven throughout our community. The associated stigmas prevent open discussion in our culture. In order to reach and aid those affected by mental health issues it is vital that we establish a holistic understanding of health in our community through providing a safe and supportive environment for individuals to obtain the assistance they need.

ISSUE MENTAL HEALTH
Goal Improve mental health in the community Outcome Objectives/Indicators §1 Increase the number of active neighborhood watch groups by 20% by 2013 §2 Decrease the rate of non-compliance among retail stores found to have sold tobacco to minors from 18.1% (2008) to 13% by 2013 §3 Implement alcohol outlet density regulation through licensing or zoning by 2014 §4 Enact policy that requires businesses that offer health insurance for their employees to require equitable coverage for mental illnesses, including alcohol-related problems by 2014 §5 Reduce the percentage of Tulsans reporting more than 15 mentally unhealthy days/months by 15% by 2014 §6 Develop mental health resource list by January 2010
Risk Factors Family history of mental illness Aging In an abusive relationship Substance abuse Impact Objectives Lower substance abuse rates Reduce the stigma attached with seeking out mental health services Increase the number of physicians educated on mental health issues Disseminate information to residents on availability of mental health services Connect mental health with total health
Direct Contributing Factors Poverty Aging Domestic violence Lack of understanding that treatment is available and works Substance abuse Depression Indirect Contributing Factors Lack of insurance coverage Cost of treatment/medications Lack of treatment resources Lack of culturally-competent care Stigma Suggested Intervention Strategies §1 Police for Positive Change (P2) o Identify and provide police contact name and number assigned to area for each active neighborhood association in Tulsa County o Develop monthly communication protocol between police and neighborhood associations o Have police train residents on the signs of potential meth labs o Create online monitoring system for neighborhood associations to post status reports from police regarding neighborhood concerns and share with other nearby neighborhoods §2 Building Up for Better Lives o Establish partnerships between faith-based organizations, mental health providers and neighborhood associations o Identify individuals at high risk for poor mental health and provide accepted standard screening tools at church events, neighborhood association meetings and other community events o Integrate at-risk individuals into established social support systems to help reduce mental health related issues and provide support to seek professional treatment o Establish and/or publish a resource list for all available mental health providers and the associated fee schedule and post throughout the community in various settings §3 Regulate for Peace of Mind o Contact ABLE and City/County officials to set baseline for current alcohol outlet density in the community o Identify areas with high proportion of risk factors and work with community residents to reduce alcohol retailers and replace with food co-ops or appropriate services §4 Shout It Out for Mental Health! o Place mental health professionals in waiting areas of high traffic medical facilities to provide information and referrals to all adult residents o Incorporate “Mental Health Days” into school calendar events and train high school students to work in teams and present to peers on mental health including signs to recognize suicide, substance abuse, and other areas of mental health. Emphasize ways to access confidential mental health services for low cost §5 Are You Covered? o Increase media coverage of 211 services, especially mental health services offered through 211 o Work with local news personalities to cover “hot topics” in mental health on a consistent basis o Reduce the stigma associated with Mental Illness and identify local celebrities who have overcome mental illness o Identify a champion in the legislature to author legislation on mental health insurance coverage in the state
Resources Available Tulsa County Sheriff’s Office (Meth Hotline) Tulsa Fire Department Tulsa Police Department Oklahoma’s Alcoholic Beverage Laws Enforcement Commission Oklahoma Grocers Association Local school districts Insurance companies Oklahoma State University School of Medicine Oklahoma University School of Medicine Tulsa Health Department-Working for Balance Mental Health Association in Tulsa 211 Local physicians Local businesses Faith-based organizations Legislation Key Contacts

Tobacco use is the number one most preventable cause of chronic disease in the United States. In order to combat this statistic our community must seek to regulate its use through combating sales to minors and implementing environmental policies.

ISSUE TOBACCO USE
Goal Reduce tobacco use in the community Outcome Objectives/Indicators §1 100% tobacco ban at all Tulsa parks, city sponsored community events, and sports and recreation facilities by 2015 §2 100% ban on the sale and advertising tobacco products at all local colleges by 2015 §3 100% ban on tobacco use at all local colleges by 2017 §4 Limit the number of tobacco retailer licenses to 1 per every 2,500 people over 18 years of age in the county by 2014 §5 Eliminate all points of sale for tobacco products within 1,000 feet of all elementary and secondary schools in Tulsa County by 2014 §6 Implement at least a $1.00 increase in the unit price for tobacco products by 2014
Risk Factors Low SES Single-parent household Adolescent (tobacco initiation) Low self-esteem Impact Objectives Reduce the number of public places where individuals can smoke Stop the tobacco industry from targeting college kids Include smokeless tobacco in tobacco prevention efforts
Direct Contributing Factors Perception that tobacco use is the norm Lack of skills to resist offers of tobacco Indirect Contributing Factors Peer pressure Addiction Lack of insurance coverage for cessation therapies Advertising of tobacco products Easy access for minors to tobacco Lack of parental support during adolescence Suggested Intervention Strategies §1 Smoke Free Tulsa o Ban smoking at all city and county government owned and sponsored events o Organize petitions from neighborhood associations requesting smoke free policies including the ban of selling tobacco products near schools o Educate community members regarding the harmful effects of Environmental Tobacco Smoke §1 Generation Tobacco Free o Work with local universities, public and private, to ban the sale and advertising of tobacco products on campus and in college-controlled publications, and events o In cooperation with the North East Tobacco-Free Oklahoma Coalition, develop college-aged SWAT (Students Working Against Tobacco) teams to reverse cultural acceptance of smoking and chewing tobacco among college- and high school-aged youth o Encourage the use and follow through of tobacco-free contracts signed by middle and high school ages o Refuse all research and sponsorship funding at colleges from the tobacco industry o Prohibit tobacco (including smoke-less) use at all indoor and outdoor facilities, private offices, residence halls, and dormitories at all local colleges §2 Operation Unaffordable o Increase unit price for tobacco products o Partner with local philanthropy to create financial and other incentives for enrolling in cessation programs o Create financial disincentives for continued tobacco use
Resources Available City Council Parks and Recreation Advisory Board Local colleges College students Legislation Tulsa County Sheriff’s Office (Meth Hotline) Tulsa Police Department Key Contacts

Affordable access to quality health care facilities needs to be a right that every Tulsa community member holds. Through executing strategies that focus not only on affordability but also on increasing the proximity of care facilities we can seek to insure that every resident has the opportunity to have their health care needs met.

ISSUE ACCESS TO HEALTH CARE
Goal Increase the density and accessibility of health care facilities Outcome Objectives/Indicators §1 Increase the density of healthcare facilities to provide access within 3 miles of every Tulsa County resident by 2015 §2 Decrease the number of uninsured Tulsa County residents 18+ from 18.1% to 15.1% by 2013 §3 Decrease the number of poor physical health days from 3.6 in 2007 to 3.0 by 2013 §4 Decrease the number of individuals who did not seek care due to expense from 17.9% in 2008 to 15% by 2012 §5 Decrease the percentage of Insure OK ESI members who delayed or did not seek care because the deductable/copay was unaffordable from 22% in 2008 to 18% in 2012 §6 Decrease the number of Emergency Room visits for non- emergency situations from 73% in 2007 to 65% in 2013 §7 Increase funding for public transit in order to increase frequency of transit opportunities by 2012 §8 Increase the number of Tulsa Country Medicaid-eligible residents receiving Medicaid to 90% by 2014 §1 Increase the immunization of children from 77.4% in 2006 to 80% in 2013
Risk Factors Uninsured Underinsured Low income Racial and ethnic minorities Childless poor adults Single parent households Unemployment Impact Objectives Improve transportation in order to improve access to health care Increase number of health care facilities in areas of greatest need
Direct Contributing Factors Poverty Lack of education Lack of coverage for specific ailments Indirect Contributing Factors Lack of knowledge Substance abuse Affordability Low access to care facilities Lack of social support Lack of family support Lack of job support Fear/Helplessness/Intimidation Complex insurance process Lack of adequate public assistance Suggested Intervention Strategies §1 Health on Wheels o Leverage public and private dollars to establish a traveling care bus for the community using public transit to pick up and drop off at a variety of health facilities around the county o Provide mid-level health professionals and/or health students with “office” on care bus to inform and educate community members on the fees, services and resources available § Prioritize Immunize o1 Partner with faith-based organizations to offer immunizations at functions on a consistent basis o2 Hold Immunization days at local health facilities twice a year targeting prenatal women and families with young children § Health Professionals for Change o1 Recruit health professionals to support health policy change §1 Increase public transit funding §2 Support the completion of sidewalks and bike lanes § Insurance Assurance o1 Provide training to all health care professionals about eligibility and application process for government assistance programs o2 Provide applications for government assisted programs at all health facilities o3 Mail applications to community residents most in need of public support §1 Empowered Youth o1 Advocate for medically-based sex education o2 Increase awareness about comprehensive sexuality education resources o3 Work with faith-based organizations to provide medically-based sex education o4 Encourage businesses to utilize Planned Parenthood’s Education Department and set up a group presentation about sexual health. Programs can be tailored to any group and guidelines (i.e. focus on relationship health, abstinence based, health risks) §2 Insure OK o1 Invite small businesses to a presentation about the ESI plan o2 Increase awareness for job fairs and employment opportunities o3 Mail eligible businesses educational pamphlets about the opportunity and its benefits §3 Work It o1 Display job opportunities clearly at all public high schools o2 Increase advertisement for Job Fairs o3 Incorporate job fairs once a month at every high school § Appointment Assistance o1 Establish on site temporary designated area for child care at high trafficked health care facilities 2 days a week for assistance during appointments o2 Recruit volunteers or already employed staff to supervise children §2 Utilize volunteer physicians and/or medical students to provide free physicals within all public schools
Resources Available Cover the Uninsured Week (March 22-28) Insure Oklahoma Sooner Care WIC SCHIP/CHIPRA Medicaid/Medicare Planned Parenthood NET WIN Kids Free Clinic Coalition Key Contacts OHCA Providers Resources currently available: employees Health Care Authority Board Public transit officials Uninsured Population College Students Public outreach/education staff

Laying the First Blocks

What can YOU do as a resident of Tulsa County?

Become an advocate!

Educate your social circle, your family, your friends, your coworkers! Anyone you can get to listen, about the possibilities outlined in this guide.

Take action!

Whether it be holding a neighborhood meeting about starting a community garden, or presenting the idea of a walking school bus to the PTA. Every effort makes a difference toward the collective good of our community.

But how? This is too much, with everything else going on right? Here are some simple steps to get involved in making a difference:

Pick up the phone, and start making some calls. Maybe childhood obesity is the issue that you care most about, go back to that template, look at the key contacts and start making some calls, hold the agencies involved in this guide responsible!

Maybe safety and crime are most important to you? Attend your neighborhood watch meeting or if your neighborhood does not have an established watch visit a nearby meeting and get the information you need to establish your own watch.

This guide is not supposed to sit on a shelf and collect dust in the offices of the agencies supporting it, it is supposed to be on YOUR coffee table, or kitchen counter, or night stand, that’s why unlike other plans that only go to public health agencies, this one is coming to you!

What can you do as a Public Health Agency or Partner?

Listen!

Review this guide and see how much of your strategic planning reflects the desires of the community you are serving.

Innovate and Partner!

Maybe you can address some of the interventions discussed in the templates; maybe you already are working on some of the pieces, but need a partner to help complete the program? Use the key contacts to help identify what other agencies you can get involved in successfully implementing some of these interventions.

Be Accountable!

As we move into the implementation phase of this guide, we will adjust the Pathways to Health website so that agencies can post updates and residents can respond and post new ideas to improve the interventions.

Sample Issues Below:

CHILDHOOD AND ADOLESCENT OBESITY

NUTRITIONAL ACCESS

AFFORDABLE, AND HEALTHY HOUSING

MENTAL HEALTH

TOBACCO USE

ACCESS TO HEALTH CARE

 

Note: The document was sent as a word document which translate poorly to direct text on the internet (i.e tables and spacing are lost). -- Ted