Assessing and Improving Community Health in Wisconsin

DePere Department of Public Health

335 S Broadway
DePere, WI 54115-2593
Brown County
Local Health Department Website
Community Health Needs Assessment
Community Health Implementation Plan
Time Frame: 2015-2017

Implementation Approaches

-By December 31, 2017, local health systems will standardize the screening for alcohol, depression, and substance abuse from youth to adulthood as evidenced by the adoption of a universal minimum standard set of questions.

  • Review evidence-based practice research on pediatric AODA screening tool
  • Pilot youth screening with selected pediatric AODA tool
  • Engage youth and family practices to use piloted screening tool for adolescent AODA screening
  • Create minimum standard set or select universal screening tool for adult AODA screening
  • Aggregate further youth data for Brown County focusing on school surveys and age of onset

-By December 31, 2017, a community-wide access platform will be created for all screened AODA patients with an established goal that improves access as measured by days from diagnosis to treatment.

  • Assess levels of care using Brown County AODA manual and identify gaps
  • Define current state of access and barriers to treatment
  • Establish current baseline for “days to treatment” from diagnosis
  • Collaborate with mental health task force to begin planning “no wrong door” platform for co-occurring disorders

-By December 31, 2015, the task force will begin to advocate for best practice policy regarding alcohol misuse in order to create a multi-faceted community approach to reducing binge drinking and driving while impaired.

  • Review literature on best practice strategies to reduce binge drinking and driving while impaired
  • Define current post-arrest treatment requirements for OWI violations
  • Develop evidence based practice education to teach the community on achieving zero drinking and driving deaths
  • Assess ordinances and municipal judge penalties for alcohol-related violations for at least two jurisdictions
  • Partner with legislators and the Tavern League to develop tactics for reducing drinking and driving
  • Compare ordinances and penalties in assessed jurisdictions to neighboring jurisdictions
  • Implement at least one evidence based strategy selected from feedback at community focus groups to reduce alcohol-related violations in at least one jurisdiction
  • Advocate on implementing at least one evidence based strategy that decreases alcohol related traffic deaths at the county or state level

-By December 31, 2017, Brown County will improve the food choices offered by food pantries by increasing the percentage of healthy food options and reducing the amount of low-nutrient foods, without reducing the total amount of food donated.

  • Continue public messaging campaign for “Food Drive Five”
  • Assess extant literature regarding healthy food policies at food banks and food pantries
  • Continue communication with food sourcing partners regarding prioritization of healthy food selection
  • Reach out to at least two area food pantries to provide education on food pantry healthy food policies
  • Determine how and when healthy food donations at future food drives will be measured
  • Select and implement at least one healthy food sourcing strategy from (Beyond Bread, Healthy Shelves, other evidence) source material in two area food pantries

-By December 31, 2017, Brown County will initiate a planning process to align food pantry infrastructure in the community to meet current and projected growth needs.

  • Utilize census tracts to identify current needs in relation to existing food pantry locations
  • Conduct a literature review of food pantry infrastructure and best practices around the country
  • Create inventory of current food pantry infrastructure and resources in Brown County
  • Create and disseminate survey of current needs and opportunities to area food pantries
  • Investigate collaboration and pooling of resources among local pantries

-By June 1, 2015 Brown County will identify and monitor community needs as they relate to non-emergency food security.

  • Maintain a standing agenda item for discussion/information regarding non-emergency food security
  • Scan the literature and current trends in non-emergency food security to stay current on best practices
  • Monitor non-emergency food infrastructure development, stabilization and best practice evolution

-By December 31, 2017, local health systems will standardize the screening for alcohol, depression, and substance abuse from youth to adulthood as evidenced by the adoption of a universal minimum standard set of questions.

  • Review evidence-based practice research on pediatric AODA screening tool
  • Pilot youth screening with selected pediatric AODA tool
  • Engage youth and family practices to use piloted screening tool for adolescent AODA screening
  • Create minimum standard set or select universal screening tool for adult AODA screening
  • Aggregate further youth data for Brown County focusing on school surveys and age of onset

-By December 31, 2017, a community-wide access platform will be created for all screened AODA patients with an established goal that improves access as measured by days from diagnosis to treatment.

  • Assess levels of care using Brown County AODA manual and identify gaps
  • Define current state of access and barriers to treatment
  • Establish current baseline for “days to treatment” from diagnosis
  • Collaborate with mental health task force to begin planning “no wrong door” platform for co-occurring disorders
  • Create a defined collaborative effort with Drug Alliance and Heroin Task Force to establish aligned vision

-Reduce the number of emergency department visits for oral health concerns that could be addressed in a dental office

  • Develop and implement a community-wide protocol (antibiotics and pain management) for use in the emergency department for patients with dental pain --share with BDK for possible additional implementation

  • Develop and implement orientation program re NEW Dental program for ED staff

  • Provide education to existing Medicaid patients on the proper use of the emergency department for dental conditions

  • Evaluate the use of the oral health resource sheet and oral hygiene kits offered to the EDs

  • Explore feasibility of increasing capacity at NEW Dental Clinic, current site or east side location

  • Explore feasibility of providing dental hygiene services to uninsured patients via the NWTC Dental Hygiene program

  • Study the use of urgent care for dental conditions; determine what share of ED visits are occurring outside of “office hours”

-Identify and implement programs to provide appropriate care to poor and needy.

  • Develop strategies to reduce ED visits for dental conditions
  • Develop strategies to reduce ED visits by Medicaid patients and provide them with care in settings appropriate to their needs
  • Provide assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare, as appropriate for their situation

-By December 31, 2017, a community-wide access platform will be created for all screened AODA patients with an established goal that improves access as measured by days from diagnosis to treatment.

  • Assess levels of care using Brown County AODA manual and identify gaps
  • Define current state of access and barriers to treatment
  • Establish current baseline for “days to treatment” from diagnosis
  • Collaborate with mental health task force to begin planning “no wrong door” platform for co-occurring disorders

-By December 31, 2017, the task force will create a document accessible to all stakeholders that identifies the current state of mental health care in Brown County, including all available resources and services provided, gaps and disparities in care, needed programs, and ratio of specific mental health providers to population.

  • Investigate Greater Green Bay Community Foundation basic needs grant to fund ongoing Behavioral Health Council to coordinate resources
  • Hold Community Mental Health mini-Summit to gather stakeholders’ assessment of current state
  • Use current data to identify disparities in care related to payer source (i.e., private insurance, medical assistance, self-pay)
  • Use existing data to identify disparities in care related to gender, race, socio-economic status, age, and/or diagnosis

-Identify and implement programs to provide appropriate care to poor and needy.

  • Develop strategies to reduce ED visits for dental conditions
  • Develop strategies to reduce ED visits by Medicaid patients and provide them with care in settings appropriate to their needs
  • Provide assistance to community members to enroll in insurance products through the market place or to enroll in BadgerCare, as appropriate for their situation

-By December 31, 2017, local health systems will standardize the screening for alcohol, depression, and substance abuse from youth to adulthood as evidenced by the adoption of a universal minimum standard set of questions.

  • Review evidence-based practice research on pediatric AODA screening tool
  • Pilot youth screening with selected pediatric AODA tool
  • Engage youth and family practices to use piloted screening tool for adolescent AODA screening
  • Create minimum standard set or select universal screening tool for adult AODA screening
  • Aggregate further youth data for Brown County focusing on school surveys and age of onset

-By December 31, 2017, the mental health task force will create a draft proposal for creating a community-wide “No Wrong Door” access platform for mental health treatment and connection between mental health providers.

  • Work with N.E.W. Mental Health Connection as model to establish similar platform in Brown County

  • Work with primary care providers to identify education needs and strengthen primary care as entry point to “Right Care, Right Person, Right Time” mental health treatment

  •  Use mental health treatment resource manual to begin creating electronic infrastructure for interagency contact

  • Investigate and implement “No Wrong Door” gatekeeper training for mental health agency frontline staff in order to successfully implement shared referral database

-By December 31, 2017, the task force will create a document accessible to all stakeholders that identifies the current state of mental health care in Brown County, including all available resources and services provided, gaps and disparities in care, needed programs, and ratio of specific mental health providers to population.

  • Investigate Greater Green Bay Community Foundation basic needs grant to fund ongoing Behavioral Health Council to coordinate resources
  •  Hold Community Mental Health mini-Summit to gather stakeholders’ assessment of current state

  • Use current data to identify disparities in care related to payer source (i.e., private insurance, medical assistance, self-pay)

  • Use existing data to identify disparities in care related to gender, race, socio-economic status, age, and/or diagnosis

  •  Breakdown mental health provider: population ratio by specific specialties (psychiatrist, PMH-NP, counselor)

  •  Create an on-line listing of mental health services/community events provided in Brown County (downloadable to PDF for a hard copy).

-By December 31, 2017, the mental health task force will create a draft proposal for creating a community-wide “No Wrong Door” access platform for mental health treatment and connection between mental health providers.

  • Work with N.E.W. Mental Health Connection as model to establish similar platform in Brown County

  • Work with primary care providers to identify education needs and strengthen primary care as entry point to “Right Care, Right Person, Right Time” mental health treatment

  •  Use mental health treatment resource manual to begin creating electronic infrastructure for interagency contact

  • Investigate and implement “No Wrong Door” gatekeeper training for mental health agency frontline staff in order to successfully implement shared referral database

-By December 31, 2017, the mental health task force will complete an inventory of all mental health screening tools currently utilized across community settings and develop a common screening platform that is appropriate for each community setting (Schools, Crisis Center, Psychiatric Hospitals, Emergency Departments, primary care, mental health clinics, and other healthcare settings). 

  • Complete an inventory of current depression screening tools used across settings

  • Complete an inventory of current suicide risk screening tools used across settings (consider collaboration with the Brown County Coalition for Suicide Prevention on this activity)

  • Identify best practice depression screening tools and develop recommendations of tools for various community settings

  • Identify best practice suicide risk screening tools and develop recommendations of tools for various community settings

Oral Health

-Reduce the number of emergency department visits for oral health concerns that could be addressed in a dental office

  • Develop and implement a community-wide protocol (antibiotics and pain management) for use in the emergency department for patients with dental pain --share with BDK for possible additional implementation

  • Develop and implement orientation program re NEW Dental program for ED staff

  • Provide education to existing Medicaid patients on the proper use of the emergency department for dental conditions

  • Evaluate the use of the oral health resource sheet and oral hygiene kits offered to the EDs

  • Explore feasibility of increasing capacity at NEW Dental Clinic, current site or east side location

  • Explore feasibility of providing dental hygiene services to uninsured patients via the NWTC Dental Hygiene program

  • Study the use of urgent care for dental conditions; determine what share of ED visits are occurring outside of “office hours”

-Develop strategies for groups where evidence has shown improved health outcomes with proper oral health care

  • Review and Refresh strategies for women aged 18-44

  •  Develop strategies for diabetic patients

  •  Develop strategies for patients with cardiovascular disease

- Formalize collaboration among groups addressing oral health

  • Explore opportunities for collaboration with MCW, e.g., incorporation of oral health in curriculum, research projects on diabetes and cardiovascular disease relationship to dental health

  • Identify at least one opportunity for collaboration among OHP , NEW Clinic and Oral Health Community Action Team

  • Explore opportunities to collaborate with BDK (Brown/Door/Kewaunee Dental Society)

-Incorporate BSS screening questions within primary care practices

  • Determine extent to which BSS screening is used in primary care and OB Care practices in Brown County

  • Advocate for broader use of BSS

  • Evaluate the usefulness of resource materials provided to practices

-Influence public policy to support oral health initiatives

  • Advocate to have Medicaid cover 2 cleanings per year

  • Advocate to have Medicaid cover dental clinic dispensing fluoride

  • Advocate for SNAP benefits to allow purchase of oral hygiene supplies

  • Advocate for dental care to be an essential health benefit for adults as well as children

  • Advocate for oral health questions to be included in the nurse licensing exam

  • Advocate for oral health questions to be included in the licensing exam for other health professionals (e.g. MD, DO, NP, PA)

  • Support efforts by local dental health professionals to secure dental student rotations in Green Bay

  • Explore feasibility of community wide campaign to promote dental wellness

  • Develop and implement a comprehensive oral health education program for health care professionals

  • Support Public Health’s efforts to retain fluoridation in public health water supplies via testimony when requested