History of Hometown Health Improvement

The Arkansas Department of Health undertook a strategic planning initiative in 1996 to ensure that they were properly focused on the future. The process was called ASPIRE, Arkansas Strategic Planning Initiative for Results and Excellence. One of the strategies developed through this process was a decision to shift the Department’s focus to emphasize assisting communities in assessing and responding to their unique health needs. To improve community health we must influence broad social, economic and political forces and the beliefs and behaviors on individuals, families, and communities. The overall health status of Arkansans will only be improved when state and local, public and private organizations and agencies team up to improve health and quality of life in communities. A team of state and local colleagues worked together to develop a plan for expanding the agency’s capacity in community health improvement. Hometown Health Improvement (HHI) was born.

History and Focus - HHI started in December 1998 with a pilot in Boone County. Since then HHI has added: 12 counties in 2000, 15 counties in 2001, 16 counties in 2002, 12 counties in 2003, and 7 in 2004. In 2007 HHI has continued to experience phenomenal growth, reaching a total of 73 counties.

It is the philosophy of the Arkansas Department of Health that in order to improve the health of Arkansans we must focus on creating systems that promote, maintain, and improve health rather than on treating illness. The philosophy is amplified by the following essential tenets: community focus, local control, data-based decision making, local/state partnership, and follow through.The role of the Arkansas Department of Health in HHI includes data collection/interpretation/use, coalition building, dissemination of information, brokering, training, and evaluation.

The role of the local health unit is to provide leadership for the community to identify health challenges and to develop solutions. Communities must be full, active participants in the process. They must determine their unique problems and the solutions to address these challenges.

Hometown Health Improvement sites provide organized approaches to identifying and implementing effective community health strategies. This model emphasizes the elimination of duplication of effort. It promotes community based health status assessment and prioritization of health issues and needs. It allows communities to create systems that plan for health, promote healthy behaviors and provide services that are appropriate for their needs. Under the Department of Health and Human Services, the Division of Health continues its focus on improving community health.

Focus on Evaluation - Developing methods of evaluation has been a main focus of HHI for the past two years. The first workgroup convened was charged with developing a way to define the HHI continuum to include all stages (phases) of the community development process. This also included defining how the agency defines both short and long-term success.

The group came up with the following phrase for the "marketing" definition of HHI: Helping Communities Plan for a Healthy Tomorrow. Upon reviewing background material, the group agreed upon the three stages: (1) Mobilization, (2) Planning, and (3) Implementing and Evaluating. The group developed a phases checklist to be used as a guide to help determine where counties are in the stages.

Donna Yutzy consulted with the HHI regional leadership to develop evaluation tools for local coalitions. The Quality Management Coalition Review has been conducted for the third year with all counties. This assessment will help determine any issues or deficiencies that need to be addressed and set goals to alleviate these.

Technical Assistance - Technical assistance is provided to HHI sites to assist communities in achieving their identified goals. HHI Regional Managers are located in each of the five Division of Health regions. They serve on the regional leadership team and have general oversight for the coordination of HHI activities in the region. They provide technical assistance to communities, participate in the development of professional standards for the agency, ensure professional competence of HHI staff, connect communities with resources, and participate in statewide planning for HHI. The HHI Regional Managers are Linda Thompson (Northwest), Joy Laney (Northeast), Darrell Montgomery (Central), Janet McAdams (Southwest), and Kaye Murry (Southeast).

The regional staff also includes HHI Coordinators who assist the regional manager with coordination of HHI activities in the region. They assist with human resource management, providing technical assistance to communities, activity planning and training, and promoting tobacco Best Practices. The HHI Coordinators are Kathleen Barham (Northwest), vacant (Northeast), Julie Harlan (Central), Joni McGaha (Southwest), and Quranner Cotledge (Southeast).

The regional HHI staff also includes Health Educators and Rural Health Specialists to provide direct support and technical assistance to local communities. They work with and assist the Hometown Health Regional Team in planning, developing, implementing and sustaining Hometown Health efforts in the region.

The Division of Health is continuing its efforts to work with schools on a broader scale through Hometown Health Improvement. The Division is working to build and maintain community partnerships to better serve students statewide. The Tobacco Settlement funds have been used to hire 17 BSN prepared Registered Nurses to be Community Health Nurse Specialists (CHNS). The position of State School Nurse Consultant (SSNC) employed by the Division of Health and housed by the Arkansas Department of Education is held by Paula Smith. The SSNC works with school nurses, school administrators, and Community Health Nurse Specialists to improve the health of school children in Arkansas. She provides professional leadership for all Arkansas school nurses and serves as a liaison for school nurses with state agencies. One Community Health Nurse Specialist is housed with the ADH Central Region, since there is no Educational Cooperative for the Central Arkansas counties. The remaining 15 nurses are housed at the 15 Educational Cooperatives around the State that serve as resources to all school districts, school nurses, and teachers. Community Health Nurse Specialists work with each Educational Cooperative and corresponding school districts on health issues. Additional training for all these nurses is being provided through the School of Public Health, also funded by the tobacco settlement. The other duties include: (1) identifying and evaluating training needs of school nurses and targeted communities with respect to tobacco prevention and cessation and other related public health issues, (2) participating in policy development and school-based enforcement of tobacco related policies, (3) linking school-based tobacco prevention efforts with local community coalitions, and (4) acting as liaison between schools, community coalitions, Hometown Health Improvement, and health care providers.

ADH and Hometown Health Improvement have also broadened efforts to work with schools specifically in support of Act 1220. The Community Health Promotion Specialists (CHPS) are employed by the Division of Health and housed in the Educational Cooperative. The Division hires these positions with input from the Department of Education and the Education Cooperative. Currently six CHPS are located at strategic, targeted locations around the state. The CHPS in the Central Region is located with the Division of Health’s Central Region office since there is no Educational Cooperative for Pulaski County. This position works with schools, community coalitions, health care providers, and the Hometown Health Regional Team to address the problem of childhood obesity. The primary focus of this position is working with schools and the community to support the implementation of physical activity and nutrition standards and policies approved by the State Board of Health and the State Board of Education.

The local health unit administrators is each county have serve as the local leader for the HHI process. This provides a local contact person and coordination of partners for each county in Arkansas. The local administrator coordinates community training, presentations, linkages with key stakeholders, building community partnerships, identifying assets and resources, and assisting in the development and implementation of community public health assessment.

State level coordination is provided through the Center for Local Public Health at the Division of Health central office in Little Rock. Stephanie Williams is the current branch chief for the Hometown Health Branch in the Center. Andi Ridgway, HHI Director, is responsible for developing and maintaining state-level partnerships, coordinating staff and program development at the state level, managing fiscal appropriations, and producing state and federal reports. The HHI branch also includes the Office of Rural Health and Primary Care to assist in maximizing partnerships with rural health care activities and providers.