For more than 20 years, Dignity Health, a health care provider in multiple states, has been investing in the health of the communities it serves through community benefit programs and community economic initiatives, including grants and low-interest loans to nonprofits addressing community needs. Investments are targeted to populations with disproportionate unmet health needs as identified through the community health needs assessment and a Community Need Index developed by Dignity Health. Since 1990, Dignity Health has awarded more than $51 million in areas such as prevention, HIV/AIDS services, behavioral health services, and improving access to care. The Dignity Health Community Investment Program has had a total loan volume of $143 million, benefiting the community-based health programs of California, Nevada, and Arizona including: providing affordable housing for seniors; access to shelters for the homeless discharged from community hospitals; and healthy food projects. To read more about this innovative program, see this brief summary [link].
Issue Category: Public Health Preparedness
Dallas Information Exchange Portal
The Dallas Information Exchange Portal (IEP) is an electronic platform which enables health care providers, community based organizations, and social service agencies to share medical and social information via a secure network. Through patient-authorized, secure two-way exchange of information, IEP is improving care transitions and increasing coordination of care around both clinical and social issues like homelessness, hunger, and substance abuse. The ultimate goal of the program is not only to improve clinical outcomes and measures, but also generate significant cost savings to health systems. The initiative began in 2014 with a $12 million grant from the W.W. Caruth, Jr. Foundation at Communities Foundation of Texas. To read more about this innovative program, see this brief summary [link].
Cultivating Health for Success
Cultivating Health for Success (CHS) established in 2010, focuses on the inclusion of safe, affordable, and supportive housing to reduce unplanned care, improve adherence to recommended treatment, and improve health care cost and outcomes as well as quality of life for participants in greater Pittsburgh. CHS serves adults with one or more chronic illnesses and those with a history of at least one year of above average use of unplanned care, such as crisis services, Emergency Department visits, and the homeless. To deliver services, CHS partners with the Allegheny County Department of Human Services, Metro Family Practice, Community Human Services, UPMC for You, and the Community Care Behavioral Health Organization. Since CHS’s inception, per-member per-month (PMPM) medical costs have decreased 11.5 percent, the average PMPM for unplanned care has decreased by 19.2 percent, and the average prescription PMPM increased by 5.2 percent for participants with a meaningful tenure in the program. CHS is funded by UMPC for You contributions. To read more about this innovative program, see this brief summary [link].
Common Table Health Alliance: Backbone for the Healthy Shelby Partnership
The Common Table Health Alliance is a regional health improvement collaborative and an Aligning Forces for Quality Community. In 2011, the Shelby County Mayor, Memphis City Mayor, and the four major health systems engaged the Common Table Health Alliance as the backbone organization for the Healthy Shelby Partnership, which is one of the key pillars of Memphis Fast Forward, a broad-based collective impact initiative. Healthy Shelby connects social service agencies with the health care system to jointly address the social determinants of health. Common Table Health Alliance has implemented evidence-based and best practices, used social media, employed education programs, coordinated partner engagement, and is tracking 12 measures. Successful programs include a safe sleep campaign and a community hypertension registry. The goal is to improve the health rankings of Memphis and Shelby County. Healthy Shelby has received core funding from the Baptist Memorial Health Care, Methodist LeBonheur Healthcare, Region One Health and Saint Francis Hospital, city and county governments, and grants from the United Way and Medtronic. To read more about this innovative program, see this brief summary [link].
Changing the Narrative About What Creates Health—Essential Steps in Improving Population Health in Minnesota
The goal of Changing the Narrative about What Creates Health— Essential Steps in Improving Population Health is to bring about critical change to effectively address the social determinants of health and achieve health equity. Launched in 2011 by the Minnesota Health Department, this initiative shifts the responsibility for health to a community level to address the conditions in which all people can be healthy through policy, systems, and environmental changes. Key strategies include: the creation of a Healthy Minnesota 2020 framework that engages partners in all sectors; community engagement via the Healthy Minnesota Partnership, establishment of cabinet-level committee on Health in All Policies; a State Health Improvement Program that outlines policy, systems, and environmental changes; and creation of Accountable Communities for Health. By focusing the narrative on what creates health (beyond the health system), community agencies and groups have become involved in health policies contributing to policy changes including: anti-bullying law; minimum wage increase; smoke-free campuses and apartments; and complete street ordinances. Minnesota has also shown decreasing rates of childhood obesity and youth tobacco use, and increasing rates of breastfeeding. This initiative is funded by State Health Department grants. To read more about this innovative program, see this brief summary [link].
Campaign to Make Delaware’s Children the Healthiest in the Nation
Since 2006, Nemours, an integrated pediatric health system, has worked to address childhood (ages 2–17) overweight and obesity in Delaware with multisector partners including: the Governor’s Office; Cabinet secretaries and other government officials; pediatric providers; child care centers; schools; principals and superintendents; and other community-based organizations. Activities include systems-level and practice interventions, such as working with state-level partners to promote healthy eating and physical activity through child care licensing, as well as creating a learning collaborative to facilitate policy and practice change. Preliminary results show a flattening of the overweight and obesity curve for Delaware children between 2006 and 2008. This successful initiative is funded by a number of sources including: Nemours Health and Preventive Services; the Robert Wood Johnson Foundation; U.S. Department of Education; U.S. Department of Agriculture; Centers for Disease Control and Prevention; General Mills Foundation; and American Heart Association. To read more about this innovative program, see this brief summary [link].
Boston Children’s Hospital Community Asthma Initiative
The Community Asthma Initiative (CAI), an initiative of Boston Children’s Hospital, began addressing health disparities in Boston neighborhoods impacted by asthma in 2005. CAI provides an enhanced model of care which includes asthma education and home visits for families with children ages 2–18 living in the Greater Boston area who were previously treated in the Emergency Department (ED) or hospitalized as a result of asthma. CAI works with partners and coalitions to address asthma health disparities by implementing changes in policies at the local and state levels. As of June 2014, case management had been provided to 1,329 patients with significant outcomes including: a 57 percent reduction in the number of children with ED visits; a 79 percent reduction in hospitalizations; a 43 percent reduction in missed school days; and 43 percent reduction in missed work days for parents. CAI is supported in part by grants, several foundations, philanthropy, Centers for Disease Control REACH US Program, American Academy of Pediatrics, the Office of Community Health at Boston’s Children’s Hospital and others. To read more about this innovative program, see this brief summary [link].
Women-Inspired Neighborhood Network (WIN Network): Detroit
In 2008, the CEOs of Detroit Medical Center, Henry Ford Health System, Oakwood Healthcare System, and St. John Providence Health System commissioned the Detroit Regional Infant Mortality Reduction Task Force to develop a plan of action to help more babies reach their first birthdays. The Task Force addresses Detroit’s infant mortality rate, which is nearly 15/1000 live births, among the highest in the nation. Working through a public-private partnership of Detroit’s major health systems, public health, academic, and community partners, the Task Force seeks to tighten the disconnected medical and social services for women. The Task Force and its WIN Network have realized a number of accomplishments as of August 2014 including zero infant deaths among more than 200 babies born to date and the enrollment of 364 pregnant women in the program. Funding for this project comes from a variety of foundations, organizations, and institutions. To read more about this innovative program, see this brief summary [link].
Nearly Half of States Score 5 or Lower out of 10 on Substance Misuse Prevention Report Card
Youth Drug Overdose Death Rates more than Doubled in 35 States in Just Over a Decade
Washington, D.C., November 19, 2015– According to a new Trust for America’s Health (TFAH) report, Reducing Teen Substance Misuse: What Really Works, 24 states scored five or lower out of 10 on key indicators of leading evidence-based policies and programs that can improve the well-being of children and youth and have been connected with preventing and reducing substance – alcohol, tobacco or other drugs – misuse.
Four states tied for the lowest score of three out of a possible 10 – Idaho, Louisiana, Mississippi and Wyoming – while two states achieved 10 out of 10 – Minnesota and New Jersey. The indicators were developed in consultation with top substance misuse prevention experts.
The Reducing Teen Substance Misuse report includes an analysis of the most recent drug overdose death rates among 12- to 25-year-olds, finding that:
- Current rates were highest in West Virginia (12.6 per 100,000 youth) — which were more than five times higher than the lowest rates in North Dakota (2.2 per 100,000).
- Males are 2.5 times as likely to overdose as females (10.4 vs. 4.1 per 100,000).
- In 1999-2001, no state had a youth drug overdose death rate above 6.1 per 100,000. By 2011-13, 33 states were above 6.1 per 100,000. In the past 12 years:
- Rates have more than doubled in 18 states (Alabama, Arizona, California, Colorado, Connecticut, Georgia, Hawaii, Idaho, Illinois, Kentucky, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, Oregon, South Carolina and Tennessee);
- Rates have more than tripled in twelve states (Arkansas, Delaware, Indiana, Iowa, Michigan, Minnesota, Missouri, New Hampshire, New York, Oklahoma, Utah and West Virginia); and
- Rates have more than quadrupled in five states (Kansas, Montana, Ohio, Wisconsin and Wyoming).
“More than 90 percent of adults who develop a substance use disorder began using before they were 18,” said Jeffrey Levi, PhD, executive director of TFAH. “Achieving any major reduction in substance misuse will require a reboot in our approach – starting with a greater emphasis on preventing use before it starts, intervening and providing support earlier and viewing treatment and recovery as a long-term commitment.”
The increase in youth drug overdose deaths is largely tied to increases in prescription drug misuse and the related doubling in heroin use by 18- to 25-year-olds in the past 10 years – 45 percent of people who use heroin are also addicted to prescription painkillers.
In addition, youth marijuana rates have increased by nearly 6 percent since 2008 and more than 13 percent of high school students report using e-cigarettes. Youth from affluent families and/or neighborhoods report more frequent substance and alcohol use than lower-income teens – often related to having more resources to access alcohol and drugs.
The report highlights 10 indicators of the types of policy strategies that can help curb substance misuse by tweens, teens and young adults:
- Limiting Access:
- 37 states and Washington, D.C. have liability “dram shop” laws holding establishments accountable for selling alcohol to underage or obviously intoxicated individuals.
- 30 states and Washington, D.C. have smoke-free laws prohibiting smoking in public places, including restaurants and bars.
- Supporting Improved Well-being of Tweens, Teens and Young Adults:
- 30 states had rates of treatment for teens with major depressive episodes above 38.1 percent.
- 29 states and Washington, D.C. increased funding for mental health services in Fiscal Year 2015.
- 21 states have comprehensive bullying prevention laws.
- 35 states have at least an 80 percent high school graduation rate.
- 31 states and Washington, D.C. have taken action to roll back “one-size-fits-all” sentences for nonviolent drug and other offenses.
- Improving Counseling, Early Intervention and Treatment and Recovery Support:
- 32 states and Washington, D.C. have explicit billing codes for Screening (questionnaires/conversations), Brief Intervention (short counseling) and Referral to Treatment (SBIRT) in their medical health (Medicaid or private insurance) programs, yet currently fewer than half of pediatricians report talking to teen patients about alcohol and other drug use.
- 31 states and Washington, D.C. have laws in place to provide a degree of immunity from criminal charges or mitigation of sentencing for an individual seeking help for themselves or others experiencing an overdose.
- 30 states and Washington, D.C. provide Medicaid coverage for all three medications approved by the Food and Drug Administration for the treatment of painkiller addiction.
“The case for a prevention-first and continuum-of-care approach is supported by more than 40 years of research, but the science hasn’t been implemented on a wide scale in the real world,” said Alexa Eggleston, senior program officer, domestic programs, Conrad N. Hilton Foundation. “It’s time to bring innovations to scale and invest in more proactive and sustained approaches that promote positive protective factors, like safe, stable families, homes, schools and communities and intervene early to address youth substance use before addiction develops.”
Reducing Teen Substance Misuse identified a set of research-based approaches and recommendations to modernize the nation’s strategy to prevent and reduce substance use and support a full continuum-of-care, including:
- Putting prevention first, using evidence-based approaches across communities and in schools. Each state should have an end-to-end network of experts and resources to support the effective community-based selection, adoption, implementation and evaluation of evidence-based programs;
- Strategically investing in evidence-based programs that show the strongest results in reducing risk factors for substance misuse, poor academic performance, bullying, depression, violence, suicide, unsafe sexual behaviors and other problems that often emerge during teen years and young adulthood;
- Integrating school-based and wider community efforts, via multisector collaboration – and effectively collecting data to assess community needs, better select programs that match with those needs and improve accountability. Schools cannot and should not be expected to solve the problem on their own;
- Renewing efforts to gain support for the adoption and implementation of evidence-based and sustained school-based programs – moving beyond decades of ineffective approaches;
- Incorporating SBIRT as a routine practice in middle and high schools and healthcare settings – along with other regular health screenings – even brief counseling and interventions can have a positive impact; and
- Increasing funding support for sustained and ongoing mental health and substance use treatment and recovery.
The report provides additional research-based recommendations for preventing and reducing youth substance misuse. It was supported by a grant from the Conrad N. Hilton Foundation.
Score Summary:
A full list of all of the indicators and scores, listed below. For the state-by-state scoring, states received one point for achieving an indicator or zero points if they did not achieve the indicator. Zero is the lowest possible overall score, 10 is the highest.
10 out of 10: Minnesota and New Jersey
9 out of 10: California, Connecticut, Maine, Maryland, New Mexico, New York and Vermont
8 out of 10: Delaware, District of Columbia, Massachusetts, New Hampshire, Ohio, Oregon, Virginia, Washington and Wisconsin
7 out of 10: Colorado, Iowa, North Carolina and Pennsylvania
6 out of 10: Alabama, Illinois, Missouri, Rhode Island and Utah
5 out of 10: Arkansas, Florida, Hawaii, Kansas, Kentucky, Michigan, Montana, North Dakota and Oklahoma
4 out of 10: Alaska, Arizona, Georgia, Indiana, Nebraska, Nevada, South Carolina, South Dakota, Tennessee, Texas and West Virginia
3 out of 10: Idaho, Louisiana, Mississippi and Wyoming
STATE-BY-STATE YOUTH DRUG OVERDOSE DEATH RANKINGS
Note: Rates include drug overdose deaths, for 2011-2013, a three-year average, for 12- to 25-year-olds. 1 = Highest rate of drug overdose fatalities, 50 = lowest rate of drug overdose fatalities. States with statistically significant (p<0.05) increases since 2005-2007 are noted with an asterisk (*), while states with a statistically significant decrease are noted with two asterisks (**).
1. West Virginia (12.6); 2. New Mexico (12.5); 3. Utah (12.1); 4. Pennsylvania (11.8); 5. Nevada (11.6); 6. New Jersey (10.7*); 7. Kentucky (10.5); 8. (tie) Arizona (10.2*) and Colorado (10.2*) and Delaware (10.2*); 11. Wyoming (9.8*); 12. Indiana (9.6); 13. Missouri (9.5*); 14. Oklahoma (9.4); 15. New Hampshire (9.3); 16. Ohio (9.1*); 17. Wisconsin (8.8*); 18. Maryland (8.5); 19. Arkansas (8.4); 20. Connecticut (8.3); 21. Illinois (8.2*); 22. Michigan (8.1*); 23. Massachusetts (7.8); 24. Alaska (7.2); 25. North Carolina (7.1); 26. (tie) Montana (7.0) and Tennessee (7.0**) and Vermont (7.0); 29. (tie) New York (6.9*) and Washington (6.9); 31. Oregon (6.5); 32. (tie) Alabama (6.2) and Louisiana (6.2**); 34. (tie) Rhode Island (6.0) and Texas (6.0); 36. (tie) Kansas (5.9) and Virginia (5.9); 38. (tie) Idaho (5.8) and South Carolina (5.8); 40. (tie) Florida (5.7**) and Minnesota (5.7*); 42. Georgia (5.2); 43. California (4.9*); 44. Maine (4.7**); 45. Hawaii (4.6); 46. Iowa (4.3); 47. (tie) Mississippi (3.7**) and Nebraska (3.7); 49. South Dakota (3.3); 50. North Dakota (2.2).
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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.
