Community Health Improvement Plan
The Community Health Improvement Plan (CHIP) is the second part of a two-part health improvement planning process. The first step was the completion of the 2019 Community Health Assessment (CHA) which evaluated health status and issues impacting Montgomery County’s population. Representatives from a variety of organizations throughout the county met to first select health priorities based on the issues identified in the CHA and then worked to collaboratively create workplans to select strategies to address these issues.
The CHIP is a three-year community-driven plan that outlines goals and strategies that will be used by coalitions, task forces, organizations, and citizens to address the identified health priorities in the community.

2020 – 2022 Community Health Improvement Plan
Maternal and Infant Vitality is a measurement of the overall health of the community. We believe that healthy moms and healthy babies will lead to a more educated, healthier community. We will leverage our resources to identify and target pregnant women, which will give us a starting point to improve the health of the overall community.
Increase adequate prenatal care & education
Maternal & Infant Vitality | 1/1/20 - 12/31/22Increase utilization of maternal & infant home visiting programs
Maternal & Infant Vitality | 1/1/20 - 12/31/22Reduce substance misuese during pregnacy
Maternal & Infant Vitality | 1/1/20 - 12/31/22Preterm birth rate
Preterm birth rateIncrease utilization of maternal & infant home visiting programs
Maternal & Infant Vitality | 1/1/20 - 12/31/22Reduce substance misuse during pregnancy
Maternal & Infant Vitality | 1/1/20 - 12/31/22Strengthen access to data related to SUID for appropriate system partners
Maternal & Infant Vitality | 1/1/20 - 12/31/22Implement Safe Sleep Ambassador Program
Maternal & Infant Vitality | Completed 2/29/20Sleep-related death rate (per 1,000 live births)
Sleep-related death rateConnect at-risk women to needed clinical and social services through Neighborhood Navigators (CHWs)
Maternal & Infant Vitality | 1/1/20 - 1/31/22Convene community events to educate and inform priority populations
Maternal & Infant Vitality | 1/1/20 - 1/31/22Increase social support for new families through parenting and fatherhood initiatives
Maternal & Infant Vitality | 1/1/20 - 1/31/22Increase access and utilization of childbirth education
Maternal & Infant Vitality | 1/1/20 - 1/31/22Black infant mortality rate disparity
Black infant mortality rate disparityDevelop Agreements with care coordinating agencies
Maternal & Infant Vitality | Completed 12/31/20Provide community education on what it is and how to use it
Maternal & Infant Vitality | Completed 12/31/20HUB Model Progress
HUB modelEngage employers to provide support for breastfeeding in the workplace
Maternal & Infant Vitality | 1/1/21 – 12/31/22Provide community education on the importantace and options for breastfeeding
Maternal & Infant Vitality | 1/1/21 – 12/31/22Breastfeeding at hospital discaharge
Breastfeeding at hospital discahargeChronic Diseases have a large impact on residents of Montgomery County; they represent 7 of the top 10 leading causes of death, and chronic disease related healthcare costs have continued to rise. Risk factors for chronic disease that affect community members include poor nutrition, a lack of physical activity, and tobacco use. Making healthy lifestyle changes like improving nutrition, increasing physical activity, and quitting tobacco can help prevent people from developing these diseases. Differences in circumstances like income, zip code, and education can affect these behaviors, making it more difficult for some individuals to adopt healthy lifestyles.
Increase walking among residents
Chronic Disease Prevention | 1/1/20 - 12/31/22Expand bike share into predominantly Black communities
Chronic Disease Prevention | 1/1/20 - 12/31/22Black adults that participate in leisure time physical activity
Black adults that participate in leisure time physical activityInclude "Health in All Policies" in land use plan
Chronic Disease Prevention | 1/1/20 - 12/31/22Increase the percent of adults in Montgomery County that participate in any physical activities or exercises other than their regular job such as running, calisthenics, golf, gardening, or walking for exercise
Adults that meet both aerobic and muscle-strengthening activitiesIncrease education on tobacco cessation
Chronic Disease Prevention | 1/1/20 - 12/31/22Work with physicians to increase cessation services
Chronic Disease Prevention | 1/1/20 - 12/31/22Increase incentive programs for quitting
Chronic Disease Prevention | 1/1/20 - 12/31/22Implement policies to restrict tobacco use multiunit housing settings
Chronic Disease Prevention | 1/1/20 - 12/31/22Low income residents who use tobacco
Low income residents who use tobaccoIncrease prevention education
Chronic Disease Prevention | 1/1/20 - 12/31/22CHW outreach/collaboration with maternity programs/fatherhood program
Chronic Disease Prevention | 1/1/20 - 12/31/22Work with the faith community to implement policy change to promote healthy eating
Chronic Disease Prevention | 1/1/20 - 12/31/22Heart Attack hospital ED visits
Heart Attack hospital ED visitsStroke hospital ED visits
Stroke hospital ED visitsHypertensive disease hospital ED visits
Hypertensive disease hospital ED visitsCardiovascular disease hospital ED visits
Cardiovascular disease hospital ED visitsAlign goals, strategies, and activities of existing coalitions andorganizations working, to address community food security anddetermine gaps
Chronic Disease Prevention | 1/1/20 - 12/31/22Enhance communication and coordination between agencies and resources.
Chronic Disease Prevention | 1/1/20 - 12/31/22Expand and focus public information efforts with consistent vocabulary to promote food equity.
Chronic Disease Prevention | 1/1/20 - 12/31/22Coordinate, improve, and expand community food security resources and activities.
Chronic Disease Prevention | 1/1/20 - 12/31/22Develop shared measurements to evaluate efforts.
Chronic Disease Prevention | 1/1/20 - 12/31/22Behavioral Health encompasses both mental health and substance use disorder. We can help improve the behavioral health of Montgomery County residents by promoting resilience and well-being, treating mental and substance use disorders, and supporting those who are experiencing or are in recovery from these conditions - along with their families and communities.
Implement Zero Suicide Framework across two healthcare system
Behavioral Health | 1/1/20 - 12/31/22Advocate for mandated universal screening tools in schools
Behavioral Health | 1/1/20 - 12/31/22Develop education and outreach to inform Montgomery County on the community impact of trauma and the resources available
Behavioral Health | 1/1/20 - 12/31/22Suicide Rate (per 100,000)
Suicide Rate (per 100,000)Redistribute Healthcare Provider Competency Survey to mental health providers in the county to identify those who are provi...
Behavioral Health | 1/1/20 - 12/31/22Provide cultural competency training to interested providers
Behavioral Health | 1/1/20 - 12/31/22Add names of culturally competent providers to the Pride Providers list
Behavioral Health | 1/1/20 - 12/31/22Work with providers to collect data on sexual orientation and gender identity of patents to begin to access access to care in th...
Behavioral Health | 1/1/20 - 12/31/22Culturally competent mental health providers
Culturally competent mental health providersDevelop educational materials and advertising that support social activities for individuals and families
Behavioral Health | 1/1/20 - 12/31/22Develop a system infrastructure that will disseminate information on free and low-cost activities
Behavioral Health | 1/1/20 - 12/31/22Resource Guide Creation Progress
Creation of resource guideAdvocate for changes in telehealth policies
Behavioral Health | 1/1/20 - 12/31/22Advocate for changes in Medicare credentialed providers
Behavioral Health | 1/1/20 - 12/31/22Implement a county-wide system to determine the barriers to equitable accessibility of behavioral healthcare and identify undersevered groups
Behavioral Health | 1/1/20 - 12/31/22Policies
Policies to improve accessibilityIdentify opportunities to support universal parenting program such as Triple P
Behavioral Health | 1/1/20 - 12/31/22Hire additional behavioral healthcare staff within healthcare settings to increase capacity
Behavioral Health | 1/1/20 - 12/31/22Healthcare Settings
Healthcare SettingsFrequently Asked Questions
While the CHIP is a community-driven and collectively owned health improvement plan, Public Health provides administrative support, tracks and collects data, and prepares quarterly and annual progress reports.
Using this online dashboard, the progress of each strategy will be reported quarterly and the status toward achieving the goals and objectives are updated annually.
A next assessment of the community’s health will be completed by 2021 and over the next year, the community will begin the process of selecting new health priorities with new workplans. A new community health improvement plan will be completed and ready for implementation by the beginning of 2023.
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03 April 20231.17 MB
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16 August 20221.11 MB
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20 September 20211.18 MB
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22 October 202011.11 MB