A CHNA is a profile of a community’s health. It is informed by data, stakeholder interviews, surveys, forums, and interested community representatives with relevant knowledge and expertise about the health of the community. Through data and community perception, a CHNA is a systematic examination of the health status within a given population to help identify key problems and assets in a community.
In 2015, the Benton-Franklin Community Health Alliance (BFCHA) undertook the community-driven process to update the 2012 Community Health Needs Assessment (CHNA). Community members confirmed that the 2016 CHNA should retain the 2012 CHNA two strategic issues of:
Improve access to health care services
The 2016 CHNA is different because it focused on healthy equity and root causes and added a third strategic issue – mental health..
BFCHA used the evidence-based community health planning process from the National Association of County and City Health Officials (NACCHO) called Mobilizing for Action through Planning and Partnerships (MAPP).
Throughout the assessment process, BFCHA invited community members and organizations to meetings to discuss social determinants of health and to inform BFCHA members on how lack of health equity has impacted the effectiveness of the Community Health Improvement Plan (CHIP).
BFCHA studied the makeup of the populations within Benton and Franklin counties to understand social and economic barriers to health care access and healthy weight. For example, this predominantly rural area presents a geographic barrier to accessing resources. Lack of education and income also created health disparities.
In March 2016, community leaders identified health equity and poverty as important themes and significant barriers to achieving our health goals. Mental health remained a recurring theme. Mental health had been partially addressed in the 2012 CHNA and CHIP through tactics under the strategic issues of health care access and obesity. It became clear that mental illness was impacting many areas in the community beyond health care such as public safety and education. Many of the causal factors that impact mental health such as Adverse Childhood Experiences (ACEs), affordable housing, social stigma, homelessness, drug abuse are the same factors affecting health equity. When both data and community concerns were considered, it was clear that mental health needed to be a separate strategic issue.
Successes and Lessons Learned
Since implementing the CHIP there have been many successes and early wins. Programs like the Community Gardens and “Good Health is Good Business” have blossomed. The hospitals have expanded facilities, services, and participated in community education. The lessons learned are that every strategy needs a champion in order to get things going and keep things moving. Strategies that were less successful served as a reminder that accountability needs to be more than simply assigning an agency to be responsible.
Current events and media proved to be important for creating a mindset of change in the community. During the 2012 CHNA cycle, the Tri-Cities made national news as the ninth most obese metropolitan statistical area in the nation. More recently, mental health issues have dominated the news and consciousness of the community.
Finally, the power of collective impact was demonstrated repeatedly in those projects that proved successful, and gives a framework to duplicate in the future. The updated CHIP will benefit from the experiences learned over the past eighteen months and will focus on upstream interventions and addressing health disparities to reduce obesity, improve access to health care and improve the mental/behavioral health system.