Birth Outcomes - Chronic Disease Prevention - Behavioral Health
The CHIP reflects the collective work of many dedicated individuals and organizations who are working to improve health in our county for groups facing health disparities as well as the population as a whole. Over the next four years, organizations throughout Montgomery County plan to work collaboratively and strategically to implement evidence-based interventions that will help to achieve CHIP goals, and ultimately, improve the overall health of the residents of Montgomery County.
CHIP Dashboard
Updated: 27 Apr 17
Goal 1 - Reduce preterm births
Key Measure
Decrease the percent of preterm births by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
11.0% |
9.9% |
11.7% |
- Completed
- In Progress
- On Hold
- Not Started
Objective 1.1
Increase the number of outpatient clinics enrolled in the Ohio Perinatal Quality Collaborative (OPQC) Progesterone Project.
| Baseline | Target | Year 1 |
|---|---|---|
|
1 |
2 |
1 |
Action Steps
- Identify and implement evidence-based practices to increase routine preconception and inter-conception health visits for women of reproductive age.
- Educate health care providers on the use of progesterone supplementation.
- Expand recruitment for progesterone supplementation program engagement.
Objective 1.2
Expand implementation of evidence-based models of prenatal care.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
2 new locations |
1 new location |
Action Steps
- Identify and assess innovative evidence-based models for potential implementation.
- Identify/target prenatal practices.
- Implement innovative models of prenatal care (i.e. Centering Pregnancy, Healthy Start) demonstrated to improve preterm birth rates and other adverse pregnancy outcomes.
Goal 2 - Reduce substance misuse in pregnant women
Key Measure
Decrease the percent of mothers smoking in the 3rd trimester by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
12.7% |
11.4% |
10.9% |
Increase the number of new healthcare practices/settings using evidence-based screening methods to identify pregnant women using alcohol by three (3).
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
3 |
0 |
- Completed
- In Progress
- On Hold
- Not Started
Objective 2.1
Decrease the percent of mothers using tobacco during pregnancy
| Baseline | Target | Year 1 |
|---|---|---|
|
12.7% |
11.4% |
10.9% |
Action Steps
- Increase capacity for evidence-based tobacco cessation support for pregnant women.
- Build local system and networks for outreach, engagement, referral, and coordinated follow up.
- Increase the number of health care providers referring pregnant women who smoke to pregnancy-tailored smoking cessation programs.
- Develop and conduct effective health communication/social marketing campaigns that promote norms of healthy behaviors before, between, and during pregnancy.
Objective 2.2
Introduce evidence-based screening methods (including the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model) to address alcohol use during pregnancy in healthcare settings that see pregnant women currently not using an evidence-based screening method.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
3 |
0 |
Action Steps
- Identify healthcare settings to implement SBIRT or other evidence-based screening methods.
- Educate providers of health care and supportive services to ensure that they have knowledge, skills, tools, cultural competence, and motivation to effectively counsel patients on substance misuse.
- Conduct a FASD awareness campaign to various community members.
- Promote a referral to treatment process for women identified as needing follow up services after screening.
Goal 3 - Reduce the infant mortality racial disparity in zip codes: 45402, 45405, 45406, 45414, 45415, 45416, 45417, and 45426
Key Measure
Decrease the Black infant mortality rate in the targeted areas by 10%
| Baseline | Target | Year 1 |
|---|---|---|
|
45402 - 12.3 45405 – 25.2 |
45402 – 11.1 45405 – 22.7 |
45402 – 9.5 45405 – 23.9 |
- Completed
- In Progress
- On Hold
- Not Started
Objective 3.1
Increase awareness among the Black community regarding the infant mortality rate and infant mortality disparity and key risk factors by implementing a variety of awareness campaigns.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
1 social media; 1 print (3 types) |
1 print (brochure); 1 audio; |
Action Steps
- Implement “One Key Question” initiative at all health care visits with women age 15-44 to promote reproductive health planning and create EPIC chart items to collect data.
- Conduct an infant mortality and prematurity awareness campaign.
- Create a plan with the criminal justice system to reach incarcerated and recently released women.
Objective 3.2
Reduce preterm births among Black women.
| Baseline | Target | Year 1 |
|---|---|---|
|
45402 - 16.0% 45405 - 14.4% |
45402 - 14.4% 45405 - 13.0% |
45402 - 16.2% 45405 - 13.8% |
Action Steps
- Ensure that Black women who have experienced a preterm birth or other adverse pregnancy outcomes receive inter-conception health care and other supportive services to prevent subsequent preterm births.
- Develop and implement local service networks and coordinating strategies to ensure that Black women with risk factors are linked to appropriate community resources.
Objective 3.3
Implement a plan aimed at increasing participation of Black women of reproductive age in patient-centered medical homes.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Plan Implemented |
Not Started |
Action Steps
- Develop a plan to improve the number of women participating in patient-centered medical homes.
- Utilize community health workers to provide enhanced social support of high-risk, preconception, inter-conception women and their families to improve practice of healthy behaviors, use of preventive health care and social services, and management of chronic medical conditions.
- Promote adoption and integration of National Standards on Culturally and Linguistically Appropriate Services (CLAS) in clinical practices and other community service organizations to increase accessibility and effectiveness.
Objective 3.4
Implement a long-term plan/strategy to address Social Determinants of Health in majority Black communities to address the infant mortality racial disparity.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Plan Implemented |
Proposals submitted to PHDMC |
Action Steps
- Align with other community sectors, government agencies, etc to develop a plan to address social determinants of health: education, affordable and healthy housing, income/employment, access to food, chronic stress (including racism), and healthy community environments.
- Implement evidence-based strategies that address infant mortality in Black communities.
- Develop a plan to collect more timely birth outcome data.
Goal 1 - Increase access to safe physical activity opportunities in zip codes: 45402 & 45406 (West Dayton), 45417 (Jefferson Township), and 45416 & 45426 (Trotwood)
Key Measure
Increase the percent of adults who reported doing any physical activity/exercise during the past 30 days (other than at work) by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
58.9% |
64.8% |
60.2% |
- Completed
- In Progress
- On Hold
- Not Started
Objective 1.1
Conduct a Safe Physical Activity study to determine safety (real and perceived) of existing parks and recreation facilities.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Study Results |
In progress |
Action Steps
- Recruit college students to assist with research (Walking trail audits, Literature review to create measurement tool).
- Gather existing crime and safety data from law enforcement.
- Conduct community focus groups and/or surveys.
- Analyze results, prepare and publish findings and recommendations.
Objective 1.2
Implement an evidence-based strategy that addresses a recommendation identified in the Safe Physical Activity study.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
1 |
Not started |
Action Steps
- Create an evidence-based practice list.
- Identify a lead agency for strategy implementation.
- Seek funding opportunities for implementation.
Objective 1.3
Increase the number of targeted communities with local Complete Streets policies
| Baseline | Target | Year 1 |
|---|---|---|
|
1 |
3 |
1 |
Action Steps
- Recruit jurisdictions to participate Complete Streets Local Policy Development workshops.
- Make presentations to city and township Councils and/or Trustees to provide an overview of Complete Streets Policy.
- Assist jurisdictions in writing local Complete Streets Policies.
Objective 1.4
Implement awareness/education campaign to promote the use of existing infrastructure (especially bike trails, school gyms, and playgrounds) for physical activity.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Campaign Implemented |
Not Started |
Action Steps
- Identify existing parks, bike trail infrastructure/ resources.
- Identify schools with shared use policies and activity programs.
- Identify public and non-profit fitness centers (community rec centers, senior centers, etc.).
- Develop an awareness/education campaign.
Goal 2 - Increase access to healthy foods
Key Measure
Increase the number of locations offering healthy food options within census tracts considered to be food deserts in Montgomery County.
| Baseline | Target | Year 1 |
|---|---|---|
|
TBD |
TBD |
TBD |
- Completed
- In Progress
- On Hold
- Not Started
Objective 2.1
Add healthy choice sections/options in convenience stores located in food desert communities.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
4 |
3 |
Action Steps
- Identify and qualify potential partner stores in “food desert communities”.
- Incentivize grocery stores with promotional advertising, resources, and materials.
- Review local established models/initiatives.
Objective 2.2
Increase the number of farmers’ markets/community gardens located in food desert communities.
| Baseline | Target | Year 1 |
|---|---|---|
|
27 |
31 |
27 |
Action Steps
- Inventory food desert communities to document existing farmers’ markets and community gardens.
- Partner with community schools, faith based organizations and community groups.
- Review EBT/SNAP usage policies at farmers markets.
Objective 2.3
Identify and revitalize food gardens that are inactive or struggling in food desert communities.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
10 |
0 |
Action Steps
- Inventory inactive food gardens in food desert communities.
- Identify inactive gardens in areas with a strong community infrastructure.
- Partner with community schools, faith based organizations and community groups.
Goal 3 - Decrease tobacco use
Key Measure
Reduce cigarette smoking by adults by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
23.8% |
21.4% |
16.9% |
- Completed
- In Progress
- On Hold
- Not Started
Objective 3.1
Increase the number of 100% smoke-free locations (schools, universities, public housing complexes) across Montgomery County.
| Baseline | Target | Year 1 |
|---|---|---|
|
13 of 17 (76%) |
15 of 17 (88%) |
17 of 17 (100%) |
Action Steps
- Create complete list of Montgomery County schools, universities, and public housing complexes.
- Determine current number of smoke free schools, universities, and public housing as baseline.
- Identify key leaders who can make these policy changes.
- Provide appropriate model policies and tools for implementation.
- Work with identified leaders to make the appropriate policy changes.
Objective 3.2
Pass local legislation to increase tobacco purchase age to 21 in Montgomery County jurisdictions.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
4 of 24 (17%) jurisdictions |
0 |
Action Steps
- Identify key leaders who can make these policy changes.
- Provide appropriate model policies and tools for implementation.
- Work with identified leaders to make the appropriate policy changes.
Objective 3.3
Increase the average annual number of Montgomery County smokers enrolling in the “Ohio Quit Line.”
| Baseline | Target | Year 1 |
|---|---|---|
|
15.3 per month |
16.8 per month |
33.1 per month |
Action Steps
- Identify cycles of national and state tobacco cessation campaigns.
- Expand local media campaign advertising the “Ohio Quit Line” (billboards, bus stops, buses) during gaps in national and state campaigns.
Goal 4 - Increase physical activity and healthy eating in children
Key Measure
Decrease the percent of children who are overweight or obese by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
41.0% |
36.9% |
49.0% |
Decrease the percent of children with food insecurity by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
20.9% |
18.8% |
22.9% |
- Completed
- In Progress
- On Hold
- Not Started
Objective 4.1
Increase the annual number of new Montgomery County childcare centers that apply for the GetUp Childcare Award.
| Baseline | Target | Year 1 |
|---|---|---|
|
44 |
48 |
48 |
Action Steps
- Conduct media and childcare center awareness campaign promoting GetUp Childcare Award.
- Send GetUp Childcare Assessment to all Montgomery childcare centers every November.
- Provide guidance/education to help centers improve nutritional and physical activity standards.
Objective 4.2
Increase the number of Montgomery County physical activity programs in targeted areas, outside of schools, available for children during the summer.
| Baseline | Target | Year 1 |
|---|---|---|
|
|
TBD |
TBD |
Action Steps
- Identify current physical activity summer programing in targeted areas (45402, 45406, 45416, 45417, & 45426) and by age groups (0-5, 6-12, & 13-18) to create baseline and target measures.
- Identify other physical activity summer programming that could be offered in targeted areas activity programs.
- Cross-reference which physical activity programs also offer Summer Food Service Program (SFSP).
- Market the identified physical activity programs in the targeted areas.
Objective 4.3
Increase the number of children participating in summer meal programs in Montgomery County.
| Baseline | Target | Year 1 |
|---|---|---|
|
78 |
86 |
|
Action Steps
- Obtain data for Summer Food Service Programs (SFSP) in Montgomery County for 2015 and 2016 to create baseline and target measures
- Send SFSP list to United Way’s Help Link
- Create attendance surveys for SFSP sites
- Cross-reference SFSP sites with sites that physical activity opportunities for children
- Develop plan to market SFSP sites
Objective 4.4
Increase the number of childcare centers in Montgomery County designated as an Ohio Healthy Program.
| Baseline | Target | Year 1 |
|---|---|---|
|
3 |
25 |
Action Steps
- Recruit childcare centers to participate in Ohio Health Programs
- Add additional trainers/training for Montgomery County
- Identify incentives for childcare centers designated as an Ohio Healthy Program
Goal 1 - Ensure access to needed behavioral health services at the right amount, at the right time, for the right person, and in the appropriate setting
Key Measure
Decrease average appointment wait time for clients with referrals for behavioral health services by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
Assessment in progress |
TBD |
TBD |
Increase the number of mental health and substance abuse treatment and prevention programs by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
Assessment in progress |
TBD |
TBD |
Increase the number of new healthcare practices/settings using evidence-based screening methods to identify pregnant women using opioids and other illicit substances by three.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
3 |
0 |
- Completed
- In Progress
- On Hold
- Not Started
Objective 1.1
Conduct county-wide needs, gaps, and system barriers analysis to include primary care and behavioral health capacity and accessibility of services.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Completed analysis |
Analysis in Progress |
Action Steps
- Determine baseline measure of current service delivery and continuum of care.
- Create a county-wide workgroup that includes system partners and community leaders who are connected to the most vulnerable populations with multiple needs.
- Evaluate current data on prevalence of mental health and substance abuse disorders and availability of mental health and substance abuse treatment and prevention programming.
- Develop recommendations for future service delivery expansion.
- Develop common performance measures and determine baseline data for change.
- Conduct wait time study of average time between referral and appointment for clients seeking behavior health treatment.
Objective 1.2
Implement a minimum of two evidence-based practice models across the continuum of care that will effectively address the results of the needs, gaps, and system barrier analysis by December 31, 2018
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
2 |
Not started |
Action Steps
- Create an evidence-based practice list.
- Seek funding opportunities for expansion and/or improvement.
- Evaluate model fidelity and effectiveness to determine sustainability and replicability.
- Advocate for regulatory changes to decrease system barriers (i.e. prescribing privileges, Medicare providers).
Objective 1.3
Implement a behavioral health public awareness campaign to reduce stigma and increase awareness of services offered.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Campaign implemented |
Campaign in progress |
Action Steps
- Define population focus and target areas.
- Define data evaluation points.
- Identify resources and potential funding needed to support the campaign.
- Develop a campaign strategy based on current resources.
- Hire professional media consulting firm to assist in design and implementation to expand public awareness of resources.
- Evaluate campaign effect.
Objective 1.4
Introduce evidence-based screening methods to address the use of opioids and other illicit substances during pregnancy in three healthcare settings that see pregnant women currently not using an evidence-based screening tool.
| Baseline | Target | Year 1 |
|---|---|---|
|
0 |
3 |
0 |
Action Steps
- Identify Behavioral Health resources targeted toward pregnant women using opioids and illicit substances.
- Identify evidence-based screening tools used to screen and refer to treatment pregnant women using opioids or illicit substances.
Goal 2 - Increase integration of primary and behavioral healthcare services
Key Measure
Increase the number of primary care providers who screen for behavioral health disorders by 10%.
| Baseline | Target | Year 1 |
|---|---|---|
|
Data collection in progress |
TBD |
TBD |
- Completed
- In Progress
- On Hold
- Not Started
Objective 2.1
Identify the number of primary care and behavioral health providers in Montgomery County who screen for both physical and behavioral health disorders.
| Baseline | Target | Year 1 |
|---|---|---|
|
In progress |
# of providers screening |
TBD |
Action Steps
- Utilize screening survey method to establish baseline number of primary care and behavioral health providers who are screening for both physical and behavioral health disorders.
- Identify the number of physicians and behavioral health organizations who have adopted integrated screening process.
- Identify the number of individuals who are interested in future training opportunities.
Objective 2.2
Increase the knowledge base of behavioral health and primary care providers in integrated care models.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
15% gain in provider knowledge |
Not Started |
Action Steps
- Develop a local learning community to expand integrated care through training opportunities and technical assistance in implementation.
- Provide Screening, Brief Intervention and Referral to Treatment (SBIRT); Mental Health First Aid and Trauma Informed Care and Integrated Care training.
- Utilize a pretest-posttest design methodology to measure the effectiveness of training.
Goal 3 - Enhance care coordination and information sharing across behavioral health and other system partners
Key Measure
Implement cross-system coordination protocols
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Protocol implemented |
Not Started |
- Completed
- In Progress
- On Hold
- Not Started
Objective 3.1
Release a request for proposals (RFP) to conduct a feasibility study to explore the capability of improving cross-systems care coordination between physical and behavioral health care providers.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Feasibility study results |
Process in progress |
Action Steps
- Create a county-wide workgroup that includes system partners.
- Conduct a review analysis of current and past initiatives and practice by gathering information from system partners, task forces, coalitions, and county-wide workgroup plans.
- Evaluate the effectiveness of current care coordination methods used.
- Identify effective care coordination models that focus on collective impact system approach for possible implementation.
Objective 3.2
Release a request for proposals (RFP) to develop and implement a cross-systems coordination model.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Coordination model implemented |
Not started |
Action Steps
- Write protocols that include goals and a plan of action that outlines mutually reinforcing activities and data driven change efforts with clear targeted outcomes and processes.
- Educate providers on the protocols by offering live community presentations.
- Implement protocols across systems of care and measure success and identify areas of improvement through performance measurement data.
Goal 4 - Reduce the use of opioids and other illicit substances
Key Measure
Decrease the number of drug overdose deaths per year.
| Baseline | Target | Year 1 |
|---|---|---|
|
259 |
246 |
349 |
- Completed
- In Progress
- On Hold
- Not Started
Objective 4.1
Finalize the Incident Management System framework of the Community Overdose Action Team (COAT), collective impact collaborative formed to address the present opioid epidemic.
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
Completed framework |
Framework complete |
Action Steps
- Convene a Steering Committee as part of the opioid epidemic collaborative.
- Select stakeholders to serve as the Backbone Support.
- Select stakeholders to serve on the Operations and Planning Sections and the Joint Information Center.
- Select stakeholders to serve on the Data Sharing Committee (branch of Planning Section).
Objective 4.2
Develop and implement the Incident Action Plans developed as part of the Community Overdose Action Team (COAT).
| Baseline | Target | Year 1 |
|---|---|---|
|
NA |
NA |
Monthly Incident Action Plan |
Action Steps
- Create broad objectives to address the opioid epidemic.
- Identify current actions occurring to address opioid misuse in the county.
- Identify short and long terms goals for the incident.
- Schedule situational updates to cover the identified operational period.
- Provide progress updates to the community quarterly.
CHIP Documents
- pdf Safe Physical Activity Study Tracking Crime in Dayton Parks (6.46 MB)
- pdf Improving Health by Increasing Parks Utilization (881 KB)
- pdf Behavioral Health Needs, Gaps, and System Barriers Analysis (1.53 MB)
- pdf Social Determinants of Health JSI Report (3.06 MB)
- pdf CHIP - Year 2 6 Month Newsletter (1.93 MB)
- pdf CHIP - Year 1 Annual Report (2.27 MB)
- pdf CHIP 9 month update (653 KB)
- pdf Baseline Data Sources (81 KB)
- pdf Priority Alignment (270 KB)
- pdf Community Health Iimprovement Plan - 2016 (3.00 MB)
- pdf 6 Month Newsletter - rel 11/2016 (842 KB)
CHIP FAQ
What is a Community Health Improvement Plan (CHIP)?
A Community Health Improvement Plan is a long-term, organized plan that will be used by a community to address identified public health priorities. A community health improvement plan is critical for developing policies and defining actions to target efforts that promote health.
How were the priorities selected for Montgomery County’s CHIP?
The priorities identified in the community health improvement planning process are birth outcomes, chronic disease prevention, and behavioral health. These priorities were selected by community stakeholders based on data analyzed in the most recent community health assessment.
Who was involved in the development of the CHIP?
Montgomery County’s CHIP reflects the collective work of many dedicated individuals and organizations who were already working to improve health in our county for groups facing health disparities as well as the population as a whole.
More than 35 community organizations representing hospitals and healthcare providers, insurance companies, city and county government, law enforcement, fire and EMS, not-for-profits, civic groups, foundations, universities, and local business participated in the development of the CHIP.
See the Acknowledgements section of the Community Health Improvement Plan document for a full list of the represented organizations.
What is an action plan?
The purpose of an action plan is to outline the specific tasks that need to be completed to reach a goal. There are 3 to 4 measurable goals identified for each CHIP priority. The goals are further broken down into objectives with associated actions steps or tasks.
What principles/concepts were considered by community stakeholders throughout the community health improvement planning process?
When selecting the priorities, goals, and objectives of the CHIP, stakeholders considered the levels of the Health Impact Pyramid, the priorities of county state, and national health plans, and the concepts of Collective Impact and Systems-Level Thinking.
- The Health Impact Pyramid describes the effectiveness of different types of public health interventions. Interventions focusing on socioeconomic factors, at the base of the pyramid, have the greatest potential to improve health. Although interventions at the higher levels have less of an impact on health, the likelihood of long-term success is maximized when strategies are implemented at all intervention levels.
- Collective Impact can be achieved when “organizations from different sectors agree to solve a specific problem using a common agenda, aligning their efforts, and using common measures of success.”
- A Systems-Level Thinking approach to community health improvement places the focus on the systems that impact health, not solely on individuals.
- In order to have the greatest impact on health, it was important that the priorities selected for the CHIP align with county, state, and national health priorities.
What is Public Health – Dayton & Montgomery County’s role in implementing the action plans of the CHIP?
While the CHIP is a community-driven and collectively owned health improvement plan, Public Health - Dayton & Montgomery County (PHDMC) provides administrative support, tracks and collecting data, and prepares quarterly and annual progress reports.
When did CHIP implementation begin?
Implementation of the CHIP began in April 2016.
How often will the public be informed of the CHIP implementation progress?
Every quarter, the status of each objective will be reported on this online progress dashboard.
Can the Action Plans be revised?
Yes, the Implementation Teams will review the action plans and suggest any needed edits to the measures, objectives, action steps, and completion dates of the action plans. The Steering Committee will meet to discuss the proposed changes and provide the final approval of the action plans that will be used for the upcoming year of CHIP implementation.
Changes to the CHIP’s action plans will be considered based on the following criteria:
- availability of data to monitor progress;
- availability of resources (funding, personnel);
- community readiness;
- evidence of significant progress; and
- alignment of goals.
When will Montgomery County select new priorities?
A new assessment of the community’s health will be completed by 2018 and over the next year, the community will begin the process of selecting new health priorities with new action plans. A new community health improvement plan will be completed and ready for implementation by the beginning of 2020.