We serve a rural, homogenous, and aging population of approximately 29,460 people in the westernmost corner of Maryland (US Census, 2017). The economic disparity between Garrett County and the rest of Maryland is striking. The US Census states that 12.4% of people live in poverty, and 19.7% of Garrett County children under 18 years old are in poverty, compared to the average rate of 10.7% throughout Maryland. Maryland ranked among the wealthiest three states, with an average household income of $73,971, Garrett County ranks below at $46,096. Our greatest public health issues stem from the lack of economic dignity that at least 1/3rd of our residents experience. Poverty and isolation are demonstrated in a variety of ways both traditionally by the lack of public transportation available and lack of specialty care to broader issues, like the lack of digitally enabled people and fragmented safety net systems. One of our charges is to develop a community health improvement plan that is responsive to the needs of the people based on the data we've collected and analyzed. The Population Health, Innovation, and Informatics unit that founded the Garrett County Planning Tool and was awarded a Promising Practice from NACCHO in 2017 have continued to evolve and transform not only the way our community collaborates to improve health but in communities across the nation! The Garrett County Planning Tool is intended to help communities create a local, data-informed vision about their current needs by meaningfully and transparently engaging all residents. This vision becomes actionable by providing a platform for the creation of a responsive community health improvement plan. Health equity through community engagement is vital for health departments initially seeking or maintaining accreditation by demonstrating high-performance through accountability and credibility with all stakeholders; our agency partners and the community at large. The digital framework guides agencies through the process of creating a measurement framework to ensure the strategies they use to improve health in a community have metrics that specifically align with the strategy they have identified. The ultimate goal being those specific strategies measured as hyper-local data becomes the primary method of program attribution. In 2017, though relatively nascent as a concept, the Robert Wood Johnson Foundation recognized the digital collaborative for community health improvement processes as a central component in the 2017 Culture of Health award for Garrett County. Also, with competitive funding earned from the Public Health National Center for Innovations, Garrett County's planning tool has been released as an open source, replicable framework. When we submitted for our promising practice the objectives we initially set out to accomplish included: Enroll 500 individuals as community health planners, participation will exceed 500 discussion posts, user record collection for 10% of Garrett County's population, the creation of 25 groups with 10 hyper-local data points will be utilized to track the progress of identified community strategies by January 1, 2018. We're pleased to report that we have exponentially surpassed our original objectives and as of today December 11, 2018, at noon, we've enrolled 1,975 individuals as community health planners. Over the last year, 54.4% of our total traffic is new users! We've tracked active participation of 13,943 discussion posts and activity updates, collected 27,240 user records including those outside the traditional service area. We've built a total of 145 Action Groups that have been created by stakeholders and community members alike, 122 of those groups are public facing and have multisectoral collaboration. We're tracking 576 hyper-local data points with the ability to visualize data trends built into each action group automatically. Data from groups involving multisectoral collaboration has been collected and analyzed for the creation of the first digital & responsive community health improvement plan, published in March of 2018. An update has already been published and is available to view: https://mygarrettcounty.com/chip/. With results like these, it's no wonder Garrett County was awarded additional funds from PHNCI to replicate their work! The integral part of the Garrett County Planning Tool that helps communities create a shared vision was bundled by Garrett County to create the Universal Community Planning Tool under the GPL v3 license, the open source code is now housed on Github and being replicated in five communities. The national press release may be viewed here: http://bit.ly/nationalpress. Impacts in practice include transforming community health planning processes as we've known them and replicating the innovation! URL https://mygarrettcounty.com, training portal for replication sites equityengage.com, replication pilot sites: alleganyspeaks.com, flatheadforward.com, ourhealthydc.org, livingwellmedinacounty.com, blueprintclackamas.com.
Nationally accredited local health departments are required to conduct a Community Needs Assessment and address those needs in a Community Health Improvement Plan. This plan is supposed to engage the community and improve our population health outcomes. The 2013 iteration of the Community Health Improvement Plan for Garrett County had less than ½ of 1 % of the total population involved in the process. Those that were involved were the same directors and leaders that have written plans like these for decades with little to no input from the people who the plan is intended to serve. This is the type of bureaucratic practice that perpetuates the health inequities and disparities in a community. We found a way to increase equity and build capacity exponentially in our county. Once our residents were aware of the two major community process their local health department conducted we needed to begin to address the second major issue, the lack of local data available to accurately measure our communities health status at any given time. Accurate and timely data are essential elements in sustaining a robust public health system that is responsive to the needs of the community. In addition to unprecedented community engagement, the Garrett County Planning Tool framework guides agencies through the process of creating a measurement framework to ensure the strategies they use to improve health in a community have metrics that specifically align with the strategy they have identified. The ultimate goal being that specific strategies measured as hyper local data becomes the primary method of program attribution. Currently, local health departments rely heavily on population health data that relates to basic core demography and is often broad and unspecialized in nature, but provides an excellent lens to begin examining a population. However, these datasets upon their release are often at least two years old, and it becomes difficult for communities to attribute programmatic successes across such a span of time. So, if a goal of public health is to be truly responsive we need to ensure the strategies we are employing in communities are indeed successful and accurately measured. Locally, the entire county is affected by the problem, 29,460 Garrett County residents. However, approximately 3,000 residents suffer in poverty and are our traditionally the most underrepresented in the County. In addition, we believe this problem is a fundamental flaw within the field of public health and this practice has the potential to transform community processes in health planning.
We would like to reach at least 10% of the entire population. By June 30, 2017 we exceeded our goal and reached 17.4%, and further exceeded it by December 1, 2017 by engaging 45.4% of our entire population. For clarification, engagement in this sense has been measured as multiple actions completed by a specific user. Community engagement has traditionally been a challenge for government agencies. Often agency stakeholders serve multiple roles and claim community member resulting in reporting inaccuracies concerning engagement due to a lack of resident involvement. Our innovative idea was the first to produce tangible results to help mitigate the issue. In a government agency we have opportunities to build trust within the community. Creating a public space and willingly engaging in transparent conversations about issues, ideas and concerns with the residents to make the community a better place proves the agency and residents work as a team. The digital platform is a way to break down barriers and allow anyone to participate at any time throughout the planning process. Giving residents a way to share what matters to them and help create solutions for their community has demonstrated an increase in equity within Garrett County through health planning. Utilizing the planning tool to track the progress made from strategies collectively chosen brings the community health improvement plan to life. It shows real success and has a much greater impact in the community than previous efforts have demonstrated because the community has an active role in accomplishing certain aspects of the community health improvement plan. The sole aspect of hyper local data has proven to be a true game changer in our community as it's specialized, immediately actionable, attributable and collective. The Robert Wood Johnson Foundation, the Public Health National Centers for Innovation, and the Maryland Department of Health have all recognized the Garrett County Planning Tool as an innovation in the field of public health in 2017. Creating a planning tool using a combination of open source technology to become a responsive data collection powerhouse that simplifies and humanizes the health planning world that is actually affordable and available to other communities is indeed new to the field of public health. This tool is recognized by NACCHO as a promising practice and a 21st century innovative practice. We are building a body of knowledge based on insights gathered from the Garrett County Planning Tool as well as our UCPT replication sites. The Garrett County Planning Tool does enable any community who implements the software architecture successfully to exceed all the requirements from the Public Health Accreditation Board concerning community engagement among many other things. This planning tool enables our county to collect terabytes of data about our population. It has built equity, increased representation and participation in community health improvement efforts. It walks agencies through the arduous process of choosing the right strategies and then becomes the central hub for evidence based strategies being implemented in the county, it actually measures multisectoral collaboration, it serves as our documentation management system for PHAB, is our performance management system, and quality improvement project initiator when programs aren't performing well, it developed our community health improvement plan based on community buy-in and there's a community dashboard and a data visualization feature for all the metrics entered into the framework. The UCPT is entirely free for other communities to replicate as an open source project. This innovation is a non-conceptual, living framework that our community has been utilizing for two years and now the UCPT measurement components are being replicated nationwide. The paradigm shift is upon us, public health's utilization of affordable digital platforms that help communities collaborate and measure change is here!
MyGarrettCounty.com is a digital community engagement collaborative implemented by the Garrett County Health Department with support from local stakeholders to increase connectivity & representation in planning processes, community engagement, and collection of hyper local data. Working as an incredibly dedicated team at the Garrett County Health Department in Oakland, Maryland, Shelley Argabrite, founder and John Corbin, developer are the dynamic team and co-creators of the Garrett County Planning Tool. Originally inspired by the inadequacies of qualitative data analysis during the community needs assessment process, the Garrett County Planning Tool set out to dive deeper in understanding the complexities many people face when dealing with issues concerning their quality of life. The local health department fosters collaboration with community stakeholders by inviting them to participate in transparent processes digitally. By minimizing traditional barriers of inconvenient meeting times, lack of transportation, and social status stigma more residents have the opportunity to share their thoughts and opinions. The planning tool was built quickly with the first section titled discussions. It is in this section that the priorities of the needs assessment were listed and then the community had the opportunity to expand upon those identified areas. Essentially this became an extended focus group and was the beginning of our rich data collection. We wanted people to understand that their thoughts, concerns, and solutions were important and heard. This was an integral step in the success and early implementation of this practice. Transparently discussing anything people posted was so unique and refreshing for our rural Appalachian community. We introduced mygarrettcounty.com internally to our Health Education and Outreach unit and explained how to use the discussion section. The Health Planning unit posted first and within a few hours employees from health education and outreach began responding. It grew very quickly as the community outreach workers introduced the planning tool to the residents of their specific communities within the county. We used gamification and other popular marketing concepts like continuous email marketing to encourage users to spread the word and help us grow the membership base. The health planning unit of the local health department introduced the concept to the Health Planning Council (HPC) which is comprised of multisectoral stakeholders ranging from leaders in healthcare to local business owners. This group convenes monthly and is charged with being the responsive entity as issues in the county arise relating to a resident's quality of life. This group was especially important as we onboarded a range of agencies across the county. The HPC knew how valuable a tool like this would be at helping us collectively address long standing problems with fresh perspectives and was instrumental in on boarding the employees of their respective agencies. Another critical partner during the first few months of implementation was our local community action agency. In order to ensure our most vulnerable residents were empowered to participate, the Health Planning unit trained the coordinators using various methods, including role playing. This training and the utilization of a social media login for members helped capture a population we had feared were digitally unenabled. We discovered a significant number of people with our lowest socio-economic status were in fact digitally enabled and were using mobile virtual network operator's (MVNO) that we could trace and helped us unlock more google analytics to dispel long held beliefs and incorrect assumptions about this population. There are many other examples of community collaboration demonstrated within mygarrettcounty.com. All 1,975 members have time and date stamped contributions to the collective work of health improvement. The documentation alone could be another submission. It is a true community collaborative that continues to grow and with each new active member changing the way our community addresses issues. Transparent dialogue between local health officials, agency stakeholders, and the general public continues to be a key component in improving equity and building capacity. Strategically investing in digital technologies allows people to collaborate more efficiently and work better as a team, which is helping us to achieve our desired outcomes. In the community discussion section of the adaptive planning tool found at mygarrettcounty.com, individuals have the space to openly discuss issues, concerns and suggest solutions to address what matters to them most. Community feedback on such a large scale has informed measure development and prioritization, marking an important step toward ensuring that measures reflect what is most important. Action groups were created to employ methods that will stimulate sustainable mobilization of the discussions in the forum and actualize strategies for community improvement. Within action groups, multisectoral partners work collectively on a strategy reporting incremental data that ensures responsiveness of the public health network in Garrett County. With 193,916 lifetime page views and 1,975 active planning partners in less than two years, the planning tool has completely changed the way our community conducts strategic health planning. What's most exciting is that we get to share this innovation with other communities! Our goal is to foster a culture of innovation in public health and successfully replicate and measure meaningful community engagement across our nation to improve health. The Garrett County Planning Tool is intended to help communities create a local, data-informed vision about their current needs by meaningfully and transparently engaging all residents. This vision becomes actionable through the digital framework by providing the platform for the creation of a comprehensive and responsive community health improvement plan. Objectives included: Enroll 500 individuals as community health planners by June 30, 2017. Participation will meet or exceed 500 discussion posts by June 30, 2017. Collect user records for 10% of Garrett County's population by June 30, 2017. At least 25 groups will be created by multisectoral partners. Develop 5 evidence-based multisectoral strategies by January 1, 2018. At least 10 data collection points will be utilized to track progress of identified community strategies by January 1, 2018. A representative Community Health Improvement Plan will be written by Jan 1, 2018. The Garrett County Planning Tool, built internally under GPL v3 licensing, went live on November 10, 2016 as a soft launch in-house with a few champion stakeholders as mentioned above. The public launch occurred on Dec 1, 2016. Activities have included on-boarding members, posting content, aiding discussions, and analyzing discussions, collecting analytics, and analyzing analytics, publishing the strategy card and raw data modules to aid the community in choosing strategies that can be measured for the collection of hyper local data. Data from groups involving multisectoral collaboration has been collected and analyzed for the creation of the first digital & responsive community health improvement plan to be published January 1, 2018. The creators of the tool did so during regular work time with no additional salary or any additional funding. As previously referenced, PHNCI awarded the health planning unit in July of 2018 with an innovation grant. The purpose of this funding is to help other communities replicate this practice with minimal staff and overhead. Additional funding was awarded through PHNCI to replicate the work through a pilot project. With support from the Robert Wood Johnson Foundation, five public health departments were awarded replication grants from PHNCI to implement the Planning Tool in their own communities. The Garrett County Health Department guides the communities through the installation and implementation of the tool to test the utility in various settings and to inform potential widespread use by the public health community. The five health department awardees are:
Allegany County Health Department (MD)
Clackamas County Public Health (OR)
District of Columbia Department of Health (Washington, D.C.)
Flathead City-County Health Department (MT)
Medina County Health Department (OH)
The agencies selected reflect a diversity of settings across the United States, giving us an excellent opportunity to expand our reach and continue to increase equity and ultimately improve health outcomes. Connecting more meaningfully with communities and bridging some of the gaps public health departments have in their ability to transparently collect hyper-local data to better inform their work by utilizing the Planning Tool is transformational in the field of public health. Since we began sharing our work, many health departments have reached out to us expressing a need to more meaningfully engage their communities and are looking for a tool like the Garrett County Planning Tool. We are excited to have this opportunity from PHNCI to help others implement and adapt this process.
The transitionary process invoked through the deployment of the Garrett County Planning Tool has empowered Garrett County leaders to utilize data in an unparalleled practice that incorporates hyper-localization lenses for analysis. Through this process, multisectoral partners have chosen to collaborate in a transparent space and uniformly report on 576 hyper-local measures tracking attribution toward community health priorities. This monthly reporting cycle provides access to actionable data that is responsive to trends within the community, creating what we've coined hyper-local datasets. The Open Data Warehouse integrates these datasets in combination with state rankings and population health indicators providing the basis for data-driven decision making in Garrett County. This powerful approach allows our community to collaborate and utilize the data features to build trust through transparency. Local process evaluation of these unique quantitative hyper-local data points occurs monthly and has revolutionized the way our community approaches solutions. Our team is able to engage residents based on data we collecting, and building new partners as we establish baselines for data we have been traditionally unable to collect. The Population Health, Innovation & Informatics unit leads the work by building the software architecture, building capacity for utilization of the planning tool, and synthesizing the information so that the data can be used by the multisectoral health planning council to be increasingly responsive to community issues. On a national scale the Garrett County Planning Tool is being formally evaluated by NORC, at the University of Chicago as an objective non-partisan research institution that delivers reliable data and rigorous analysis to guide critical programmatic, business, and policy decisions. The findings of this study have yet to be released as our official evaluation period ended mid-December. We anticipate an exhaustive evaluation focusing on both process and outcome with not only the quantitative data mentioned above but also the rich qualitative data that harness the local knowledge and lived experience of our community members that represents the comprehensive community representation in decision making that was largely ignored before this innovative approach took root. Evaluating the public health problems this tool set out to solve is another area we have invested significant effort, publishing the National Community Engagement Survey. We surveyed over 100 communities in 2017 and found we are not alone in our struggles. Communities across the United States, including a few external territories, were surveyed detailing community composition, awareness, engagement, data strategies, data collections, and opportunities to improve representation. We found that: awareness of community improvement process weighed in at less than 5% of community members, 98% of the communities surveyed experienced difficulties with community engagement, and 61% reported gaps in information as a barrier to community engagement. The complete findings are available here https://equityengage.com/national-community-engagement-analysis-survey-results-dataset/ This tells us community engagement is very difficult and public health professionals trying to do this work are having the same issues we were having in Garrett County, Maryland. We're solving problems, removing obstacles and measuring the work as it happens, every community charged with completing the mission of public health needs this platform!
To date all of our objectives have either been met or far exceeded, and most indicators are currently experiencing the initiation of economies of scale that should propel community efforts further. We've enrolled 1,975 individuals as community health planners. Over the last year, 54.4% of our total traffic is new users! We've tracked active participation of 13,943 discussion posts and activity updates, collected 27,240 user records including those outside the traditional service area. We've built a total of 145 Action Groups that have been created by stakeholders and community members alike, 122 of those groups are public facing and have multisectoral collaboration. We're tracking 576 hyper-local data points with the ability to visualize data trends built into each action group automatically. Primary data sources for this project include the open source framework the Garrett County Planning Tool is based on (Universal Community Planning Tool; GPLv3), Facebook and Twitter Insights, Google Analytics, PatTrac, Empower, and several other proprietary data systems. Data from these sources are reported on a continuous or monthly basis (dependent upon agency ability) to the Garrett County Planning Tool by either mechanical or automated means whenever possible (i.e.; analytics). Secondary data sources utilized in conjunction with this community process include the Maryland SHIP indicators, RWJF County Health Rankings and Roadmaps, Census data, and numerous other open/public datasets. Performance measures for this project are set and modified through the process itself. Each component of this project and those programs being tracked have objective measures in place, such as population penetration and engagement rates, service utilization, and several blossoming measures based sociodemographic indicators related to the social determinants of health. For a full reference of the measures set through this process, please visit the action groups on mygarrettcounty.com/groups, there any guest of the planning tool can view a chart with data per month on the following in addition to data visualization. We are also collecting data from our replication sites, though relatively nascent in the implementation of the planning tool these diverse communities collectively have 319 active planning partners and 64 action groups. We are so excited to build a body of work from this innovative and practical approach to community engagement and hyper-local data collection.
Developing sustainable systems should be of the utmost priority for public health innovations. Thankfully, due to technology and the decreased need for human capital in semi-automated systems, the Garrett County Planning Tool can continue to operate in perpetuity with relatively minimal overhead – two staff members. While most work is coordinated by the Population Health Unit, only a small portion of technical maintenance time is required to update SPAM definitions and ensure security patches are installed in a timely manner, with our specific case support coming from one of the two Population Health Unit members. Any additional technological support is purely for the adaptation or expansion of the tool. Additionally, the collaborative, multisectoral approach taken by the Garrett County Planning Tool diffuses systems maintenance responsibilities as additional community agencies recognize the immense value and literal capital value of the tool. The Garrett County Planning Tool has been a tremendously successful collaboration case study for our community as it has reinforced existing relationships, fostered new and emerging opportunities, and developed transparent and self-documenting processes to record how our community collaborates to make effective change both within public health and the social determinants of health. Several cost-benefit analyses were completed throughout this process for a variety of purposes. First, a cost-benefit analysis was initiated to determine the cost of developing an open source system versus deploying a market alternative. Unfortunately, for a rural, Appalachian community, the alternatives were far too limiting for the scope needed within this project, and exponentially expensive for a community working tirelessly to support existing programs and infrastructure. This analysis became the landmark case for developing and releasing work as available open source modules that any community could adopt and replicate without sustaining exorbitant costs. Several other analyses were also conducted for individual components and expansions, primarily in the fields of engagement development and onboarding community members. Stakeholder commitment is the underlying glue that binds the entire process of deploying and effectively utilizing the Garrett County Planning Tool in practice. Local stakeholders have taken an affectionate stance to incorporating the Garrett County Planning Tool into their work, and such efforts were a primary contributing factors to the recent distinction of Garrett County being named the first Culture of Health community in the state of Maryland. Sustainability plans for the Garrett County Planning Tool are as follows: 1. Collaborate with PHNCI (Public Health National Centers for Innovation), a division of PHAB and the Robert Wood Johnson Foundation to support the open source release of modules and an accompanying framework for replicating this tool in community across the globe. 2. Work with our selected pilot sites in conjunction with PHNCI (Public Health National Centers for Innovation), a division of PHAB and the Robert Wood Johnson Foundation to continue developing the body of work including but not limited to data insights. 3. Develop and release additional programs, additions, and expansions through grant and local funding opportunities in collaboration with a variety of multisectoral programs to support ongoing maintenance and development costs.
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