Belt Stroke Elimination Initiative 2004 2008 Stroke Belt Community Action Team Plan (SBCAT)
Overview: South Carolina has led the nation in stroke mortality per capita since 1930 and has been called the `buckle' of the Stroke Belt. Hospital costs alone for stroke and other diseases of the heart and blood vessels exceed $1,100,000,000 annually in our State with a total cost of more than $3 billion each year. Thus, stroke and heart disease exert an enormous health and economic toll on South Carolinians with a disproportionate share of the burden in African Americans. Not only is stroke more common in African Americans, it often strikes 10 20 years earlier in life with more devastating consequences for families and communities. In 2004, the U.S. Department of Health and Human Services funded three applications to develop and test models for addressing the burden of stroke in the Southeast, especially among African Americans. The main objective of the award is to focus existing resources to reduce and control risk factors for stroke and to ensure that individuals with stroke symptoms receive prompt and effective medical attention. Stakeholders in the process include but are not limited to community (family) health centers, community action agencies, formal and informal community leaders, churches, civic groups, state and local government, businesses, and other like-minded individuals and groups. South Carolina received one of the three awards issued to address stroke with a focus on the four county region including Berkeley, Charleston, Dorchester and Orangeburg. The four-year goals are to: 1. Reduce stroke mortality by 15% among African Americans (AA) 2. Reduce emergency visits and hospitalization for hypertension by 50% in AA The goals are being addressed through two main approaches: 1. Healthy lifestyles (nutrition and exercise) 2. Access to medical care (medical home) and prescription medications These broad goals recognize that there are many pressing health needs of citizens throughout the region. Therefore, the goals of the SBEI must coincide and support the efforts of other health initiatives in order to achieve mutual and complementary aims. Healthy lifestyles and an effective medical home represent the basis for promoting health and for preventing and treating a variety of chronic diseases. The Stroke Belt Community Action Team (SBCAT), comprised of stakeholders noted above, met four times between September 25, 2004, and August 24, 2005 to develop and refine the SBCAT Plan. The Plan is to be shared and implemented through the County Action Teams in each of the four participating counties. Five Workgroups of the SBCAT convened during the 2nd 4th meetings of the SBCAT and at other times to develop the Mission, Objectives, Strategies, Activities, and Strategic Analyses in 5 key areas. These Workgroups include: i. Infrastructure ii. Education and Awareness iii. Lifestyle Intervention iv. Access to Care and Medications v. Advocacy
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A 6th group, Program Evaluation, is available to assist the other 5 Workgroups in assessing the process, impact and outcome objectives. The members of the SBCAT Workgroups are provided on page 14. The recommendations of the 5 Workgroups are summarized in this document. The SBCAT believes this Community Action Plan is a good beginning to address the burden of hypertension and stroke in the quad-county region, yet much more needs to be done. During 2006, the SBCAT will work together with the County Action Teams to adapt and implement the plan at the local level and work to secure additional resources that are required for success. During 2007 2008, the SBCAT will assist in evaluating the process and impact of the programs that were implemented and work to sustain the collaborative relationships and to secure the necessary resources. The Stroke Belt Elimination Initiative and all members of the Stroke Belt Community Action Team are committed to the long-range goal of facilitating the transition of our region from "a leader in cardiovascular disease to a model of cardiovascular health." This is a long-range goal worthy of our best efforts. Through the promotion and implementation of healthy lifestyles and ensuring that all of our citizens have an effective medical home and access to necessary prescription medications, we can take a major step forward in becoming the model of cardiovascular health. Sincerely yours,
Brent M. Egan, MD Principal Investigator
Sheryl S. Mack, MS Project Coordinator
Daniel Hoskins, MS Deputy Coordinator
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Contents
Leadership Contacts Partner Agencies Workgroup Members 5-11 12-13 15-16
Infrastructure Workgroup Plan
Final Plan SWOT Analysis Notes Appendices 17-18 19-25 27 29-38
Education & Awareness Workgroup Plan
Final Plan SWOT Analysis Notes Appendices
39-41 42-48 49 51-60
Lifestyle Intervention Workgroup Plan
Final Plan SWOT Analysis Notes Appendices
61 62-68 69 71-80
Access to Care & Medication Workgroup Plan
Final Plan SWOT Analysis Notes Appendices
81 82-88 89 91-100
Advocacy Workgroup Plan
Final Plan SWOT Analysis Notes Appendices 3 101 102-108 109 111-120
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Leadership Contacts
Sara Harden Ballard, Communication Director American Heart Association Mid Atlantic Affiliate American Stroke Association / Website: www.strokeassociation.org 520 Gervais Street, Ste., 300 Columbia, SC 29201 [phone] / [phone] / Fax [phone] / Email: [e-mail] Joyce Shaw Battiste, MS, Educator and Keith B. Battiste, Retired Businessman 412 Meadowlark Drive, NE Orangeburg, SC 29118 [phone] Carolyn Bivona, Director State Health Alliances American Heart Association Mid Atlantic Affiliate 520 Gervais Street, Ste., 300 Columbia, SC 29201 [phone] / [phone] / Fax [phone] / Email: [e-mail] Priscilla Brantley, RN, BSN, Sr. Clinical Coordinator South Carolina Primary Health Care Association 2211 Alpine Road Ext. Columbia, SC 29223 [phone] / Fax [phone] / Email: [e-mail] Barbara Brooks, CEO Black River Healthcare, Inc. PO Box 578 / 12 West South Street Manning, SC 29102 [phone] / Fax [phone] / Email: [e-mail] Colleen Browne, RN, MSN, MPH, APRN-BC, Associate Professor, Nursing Program South Carolina State University 300 College Street, NE / PO Box 7158 Turner Hall, D Orangeburg, SC 29117 [phone] / Fax [phone] Debbie Chatman Bryant, RN, MSN, Patient Navigator Nurse Manager MUSC Hollings Cancer Center Cancer Prevention and Control 86 Jonathan Lucas Street / PO Box 250955 Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] Theresa Chandler, MSN, APRN-BC, Community Outreach Director The Regional Medical Center of Orangeburg and Calhoun Counties 3000 St. Matthews Road Orangeburg, SC 29118 [phone] / Fax [phone] / Email: [e-mail] The Honorable Willie R. Davis, Vice Chair 5
Dorchester County Council 201 Johnston Street St. George, SC 29477 [phone] / Fax [phone] / Email: [e-mail] Reverend Cecil Diggs, III, Director HuMan Expedition 1111 Lango Avenue Charleston, SC 29407 [phone] / Email: [e-mail] Brent M. Egan, MD, Professor of Medicine & Pharmacology, SBEI Project Director MUSC Department of General Internal Medicine, Hypertension Section 135 Rutledge Avenue, Room 1104 / PO Box 250591 Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] Casey Fitts, MD, Medical Director Tri-county Project Care 5296 Rivers Avenue, Ste. 309 North Charleston, SC 29406 [phone] / Fax [phone] Elizabeth Ganaway, RN, BSN, CEO and Eddie Ganaway, MA Angels of Mercy Mobile Outreach Ministry 2309 Pristineview Road Charleston, SC 29414-4959 843-763-2922 / Email: [e-mail] R. Delores Gibbs, MD Berkeley Medical Center & Internal Medicine 106 West Main Street Moncks Corner, SC 29461 [phone] / Fax [phone] Barbara Grice, MS, CHES, Director of Health Education SC DHEC Region 5, Serving Aiken, Allendale, Bamberg, Barnwell, Calhoun and Orangeburg Counties 1550 Carolina Avenue / PO Box 1126 Orangeburg, SC 29116 [phone] / Fax [phone] / Email: [e-mail] Megan Hazelman, Health & Wellness Coordinator Trident United Way / Website: http://www.tuw.org PO Box 63305 North Charleston, SC 29419 [phone], ext 272 / Fax [phone] / Email: [e-mail] Katharine Hendrix, PhD, MS Hypertension Initiative MUSC Department of General Internal Medicine, Hypertension Section 135 Rutledge Avenue, Room 1106 / PO Box 250591 Charleston, SC 29425 6
[phone] / Fax [phone] / Email: [e-mail] Karen Hill, Community Health and Chronic Disease Program Manager SC DHEC Region 7, Serving Berkeley, Charleston, and Dorchester Counties 4050 Bridge View Drive, Suite 600 North Carolina, SC 29405 843-746-3866 / Fax [phone] / Email: [e-mail] Daniel Hoskins, SBEI Deputy Coordinator / Website: strokefreezone.musc.edu MUSC Department of General Internal Medicine, Hypertension Section 135 Rutledge Avenue, Room 1115 / PO Box 250591 Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] Reba Hough-Martin, Deputy Director Charleston County Human Services Commission PO Box 20968 / 1069 King Street Charleston, SC 29403 [phone] / Fax [phone] / Email: [e-mail] The Honorable Curtis Inabinett, Jr., CEO, Cardiac Imaging & Sound Ravenell Town Council PO Box 188 Ravenell, SC 29470 843-729-4235 / Fax [phone] / Email: [e-mail] Carrie Houser James, MSN, RN, CNA, BC, CCE, Director SCSU 1890 Res. & Ext., Service Learning PO Box 7336 / 300 College Street, NE Orangeburg, SC 29117 [phone] / Fax [phone] / Email: [e-mail] Michele D. James, LMSW, Assistant Director SC DHEC Office of Minority Health 2600 Bull Street Columbia, SC 29212 [phone] / Fax [phone] / Email: [e-mail]
Carolyn Jenkins, DrPH, FAAN, RD, CDE, Professor, Director, MUSC REACH 2010
College of Nursing 99 Jonathan Lucas Street, Room 425 / PO Box 250160 Charleston, SC 29425 [phone] / Fax [phone] / Web musc.edu/reach Genevieve Jones, MD, Medical Director Sea Island Medical Centers, Inc. 3627 Maybank Highway Johns Island, SC 29455 [phone] / Fax [phone] Jacquetta P. Jones, Program Coordinator II, Project Export Export Center for Metabolic Syndrome & Minority Health MUSC Vice President Academic Affairs / Office of Special Initiatives 7
Carriage House- 1591/2 Rutledge Avenue / PO Box 250218 Charleston, SC 29425 [phone] /Fax [phone]/Email [e-mail]/Web musc.edu/cores/cores.html Donna S. Jordan, SBEI Administrative Coordinator MUSC Department of General Internal Medicine, Hypertension Section 135 Rutledge Avenue, Room 1115 / PO Box 250591 Charleston, SC 29425 [phone]/Fax [phone]/Email: [e-mail]/Web strokefreezone.musc.edu Jeannette Jordan, MS, RD, CDE Value Medical, Inc. 107 Kilkenny Avenue Goose Creek, SC 29445 [phone] / Fax [phone] / Email: [e-mail] Arthur Kennedy, MD, CEO Family Health Centers, Inc. 3310 Magnolia Street Orangeburg, SC 29115 [phone] / Fax [phone] / Email: [e-mail] Charles Kilgore, MD, Medical Director Family Health Centers, Inc. 3310 Magnolia Street Orangeburg, SC 29115 [phone] / Fax [phone] / Email: [e-mail] Marilyn Laken, PhD, RN, Director MUSC Vice President Academic Affairs / Office of Special Initiatives Carriage House 159 Rutledge Avenue / PO Box 250218 Charleston, SC 29425-0403 [phone] / Fax [phone] / Email: [e-mail] Sheryl S. Mack, SBEI Program Coordinator / Website: strokefreezone.musc.edu MUSC Department of General Internal Medicine, Hypertension Section 135 Rutledge Avenue, Room 1115 /PO Box 250591 Charleston, SC 29425 [phone] / [phone] / Fax [phone] / Email: [e-mail] Winston Mack, Chairman National Baptist Deacon's Convention 3351 Miller Drive Ladson, SC 29456-3822 [phone] Jimetta Martin, Church Health Coordinator Moncks Corner AME Church 306 West Main Street Moncks Corner, SC 29461 [phone] / Fax [phone] / Email: [e-mail] 8
Pamela Mazyck, PharmD, Clinical Associate Professor MUSC Pharmacotherapy Clinic 135 Rutledge Avenue, Room 103-B Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] Dorothy L. McCray, RN, BSN, Case Manager Naval Weapons Station 3600 Rivers Avenue North Charleston, SC 29405 [phone] / Fax [phone] / Email: [e-mail] Virginia Milton, Executive Director Jenkins Hill Community Development Corporation, Inc. PO Box 238 Dorchester, SC 29488 [phone] / Fax [phone] / Email: [e-mail] Carlon J. Mitchell, APRN, MPH, Regional Nursing Director SC DHEC Region 7 Serving Berkeley, Charleston, and Dorchester Counties 4050 Bridge View Drive, Ste., 600 North Charleston, SC 29405 [phone] / Fax [phone] / Email: [e-mail] Lee H. Moultrie, II, Health Consultant Lee Moultrie & Associates PO Box 42134 Charleston, SC 29423 [phone] / Email: [e-mail] Nancy Olson, MPH, Program Administrator Palmetto Project PO Box 31075 / 4 Carriage Lane, Suite 100 Charleston, SC 29417 [phone] / Fax [phone] / Email: [e-mail] Roberta H. Pinckney, Executive Director St. James-Santee Family Health Center, Inc. 1189 Tibwin Road / PO Box 608 McClellanville, SC 29458 [phone] / Fax [phone] / Email: [e-mail] Ronald A. Ravenell, Executive Director Franklin C. Fetter Family Health Center, Inc. 51 Nassau Street Charleston, SC 29403 [phone] / Fax [phone] / Email: [e-mail] David Rivers, Director, Public Information and Community Outreach (PICO) MUSC Library Science and Informatics / Website: http://pico.library.musc.edu 171 Ashley Avenue, Suite 419 / PO Box 250403 Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] 9
William S. Robinson, MA, Executive Director Black Men's Health Initiative 1830 St. Michaels Road Columbia, SC 29210 [phone] / Email: [e-mail] or [e-mail] Gardenia B. Ruff, MSW, Executive Director SC DHEC Office of Minority Health 2600 Bull Street Columbia, SC 29212 [phone] / Fax [phone] / Email: [e-mail] Michelle Sears, RN, BSN, Director of Nursing and Quality Corporate Compliance Officer St. James-Santee Family Health Center, Inc. 1189 Tibwin Road / PO Box 608 McClellanville, SC 29458 [phone] / Fax [phone] / Email: [e-mail] John Simkovich, DDS, MHA, Region 7 Health Director SC DHEC Region 7 Serving Berkeley, Charleston, and Dorchester Counties 4050 Bridge View Drive, Ste., 600 North Charleston, SC 29405 [phone] / Fax [phone] / Email: [e-mail] Stephen Skardon, Jr., Executive Director Palmetto Project PO Box 31075 / 4 Carriage Lane, Suite 100 Charleston, SC 29417 [phone] / Fax [phone] / Email: [e-mail] Sabra Slaughter, PhD, Chief of Staff MUSC Office of the President PO Box 250001 Charleston, SC 29425 [phone] / Fax [phone] / Email: [e-mail] Rosa Snipes, Meds-I-Assist Program Coordinator Trident United Way (Dorchester County) 400 Duboise Road Summerville, SC 29483 [phone] / Fax [phone] / Home [phone] Andre Stanley, MPH, Cultural Competence/Special Projects Coordinator SC DHEC Office of Minority Health 2600 Bull Street Columbia, SC 29212 [phone] / Fax [phone] / Email: [e-mail] Rosetta Swinton, RN, BSN, FCN, Director of Health, HEALTH-E-AME Seventh Episcopal District AME Church MUSC V ice President Academic Affairs / Office of Special Initiatives Carriage House 159 Rutledge Avenue / PO Box 250218 10
Charleston, SC, 29425 [phone] Fax [phone] / Email: [e-mail] Betsy Whaley, MA, Rehab Liaison HEALTHSOUTH Rehabilitation Hospital of Charleston 9181 Medcom Street North Charleston, SC 29406 [phone] / Fax [phone] Carrie F. Whipper, Program Coordinator Palmetto Project PO Box 31075 / 4 Carriage Lane, Suite 100 Charleston, SC 29417 [phone] / Fax [phone] / Email: [e-mail] Queen White, Customer Service Representative St. George Medical Center 401 Ridge Street St. George, SC 29477 [phone] / Fax [phone] Brenda Williams, Vice President The Regional Medical Center of Orangeburg and Calhoun Counties 3000 St. Matthews Road Orangeburg, SC 29118 803-395-2461 / Fax [phone] / Email: [e-mail] Diane Wilson, Executive Director SC African American Tobacco Control Network / Website: www.SCAATCN.org 230 Scaleybark Road Summerville, SC 29485 [phone] / Fax: [phone] / Email: [e-mail] Calvin Wright, Executive Director OCAB Community Action Agency / Website: www.ocabcaa.org P.O. Drawer 710 Orangeburg, SC 29116-0710 [phone] / Fax [phone] / Email: [e-mail] Lathran J. Woodard, Executive Director South Carolina Primary Health Care Association 2211 Alpine Road Ext. Columbia, SC 29223 [phone] / Fax [phone] / Email: [e-mail] Gardenia Washington Young, Meds-I-Assist Program Coordinator Trident United Way (Berkeley County) PO Box 158 Cross, SC 29436 Home [phone] / Fax [phone]
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Partner Agencies AARP South Carolina Angels of Mercy Mobile Outreach Ministry American Heart Association American Stroke Association Berkeley Medical Center & Internal Medicine Berkley Diversified Services, Inc. Black Men's Health Initiative Black River Health Care, Inc. Cardiac Imaging & Sound Carolinas & Georgia Chapter American Society of Hypertension, Inc. (ASH) Charleston County Human Services Commission Committee On Better Racial Assurance (COBRA) Human Services Agency Commun-I-Care, Inc. Dorchester Community Development Corporation Family Health Centers, Inc. Franklin C. Fetter Family Health Center, Inc. Glory Communications, Inc., WSPX 94.5 FM Orangeburg Hands on Health of South Carolina HealthSouth Rehabilitation Hospital of Charleston HuMan Expedition, Inc. Jenkins Hill Community Development Cooperation Lee Moultrie & Associates Moncks Corner AME Church Moncks Corner Baptist Church MUSC, Hollings Cancer Center MUSC, Office of the President MUSC, Office of Special Initiatives MUSC, Project Export MUSC, Public Information and Community Outreach (PICO) MUSC, REACH 2010 National Baptist Deacon's Convention, USA and its auxiliaries, Inc. Field Workers Naval Weapons Station Orangeburg-Calhoun-Allendale-Bamberg Community Action Agency (OCAB) 12
Palmetto Project St. James-Santee Family Health Center Sea Islands Medical Centers, Inc. Seventh Episcopal District/Health-E-AME South Carolina African American Tobacco Control Network South Carolina Black Media Group, Inc. South Carolina Area Health Education Consortium (SC AHEC) South Carolina DHEC, Division of Cardiovascular Health South Carolina DHEC, Office of Minority Health South Carolina DHEC, Region 5, Serving Aiken, Allendale, Bamberg, Barnwell, Calhoun, and Orangeburg Counties South Carolina DHEC, Region 7, Serving Berkeley, Charleston, and Dorchester Counties South Carolina Primary Healthcare Association South Carolina State University, College of Nursing South Carolina State University, 1890 Research & Extension, Service Learning, Project Export The Regional Medical Center of Orangeburg & Calhoun Counties Tri-County Black Nurses Association Tri-County Project Care Trident United Way, Med-I-Assist (Berkeley County) Trident United Way Health & Wellness Program, (Charleston) Trident United Way, Med-I-Assist (Dorchester County) Tri-State Stroke Network US Department of Health and Human Services Value Medical, Inc. Woman's Baptist Educational and Missionary Convention of South Carolina WPAL 100.9 FM P.M. Urban Edition Talk Show WCSC-TV 5, CBS Affiliate
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Workgroup Members
Infrastructure Workgroup
Dorothy L. McCray, Group Leader Daniel Hoskins, Resource Liaison Debbie C. Bryant Geneva Fleming Michelle Sears Brenda Williams Dianne Wilson
Education & Awareness Workgroup
Carrie F. Whipper, Group Leader Rosetta Swinton, Resource Liaison Carolyn Bivona Theresa Chandler Eddie Ganaway Elizabeth Ganaway R. Delores Gibbs Virginia Milton Carlon J. Mitchell William S. Robinson Betsy Whaley
Lifestyle Intervention Workgroup
Charles Kilgore, Group Leader Jeannette Jordan, Resource Liaison Cecil Diggs, III Karen Hill Carrie Houser James Megan Hazelman Curtis Inabinett, Jr. Roberta Pinckney John Simkovich Queen White
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Access to Care & Medication Workgroup
Priscilla Brantley, Group Leader Pamela Mazyck, Resource Liaison Sheryl Mack, Resource Liaison Casey Fitts Jimetta Martin Reba Hough Martin Ronald A. Ravenell Stephen Skardon Rosa Snipes Lathran J. Woodard Gardenia Young
Advocacy Workgroup
Andre Stanley, Group Leader Donna Jordan, Resource Liaison Barbara Brooks Brent M. Egan Arthur Kennedy Michele James Lee H. Moultrie, II Calvin Wright
Evaluation Workgroup
Barbara Grice, Group Leader Brent M. Egan, Resource Liaison Sara Harden Ballard Colleen Browne Marilyn Laken Nancy Olson Sabra Slaughter
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Stroke Belt Elimination Initiative Community Action Team Plan
Workgroup 1: Infrastructure
Mission: Seek input from the community on education, economic development and communication related to stroke prevention. Key Objective: Educate adults at risk of stroke about stroke prevention, recognizing symptoms, appropriate emergency response to stroke and blood pressure control.
Strategy 1. Stroke Prevention, Education, & Screening. a. Increase health education opportunities for seniors at risk b. Improve communication systems broadly related to preventing stroke c. Expand the number of those at risk who have the tools for measuring blood pressure d. Increase health education for youth Activities: a. Improve lifestyle to prevent hypertension and other stroke risk factors b. Motivate adults to adopt healthy lifestyles and get primary care for stroke prevention c. Encourage schools to add a health component including nutrition and physical activity to reduce obesity and other risk factors for stroke and heart disease
Strategy 2. Acute stroke response. a. Ensure that youth and adults respond appropriately to acute stroke symptoms, i.e., contact EMS b. Ensure rapid response of EMS teams to individuals with stroke symptoms c. Timely transport of individuals with stroke symptoms to a health facility that can promptly evaluate and treat acute stroke
Strategy 3. Professional healthcare development. a. Short term: Enhance cultural sensitivity of current healthcare professionals b. Long term: Increase supply of health care professionals that reflect the makeup of the community served with a focus on increasing the pool of minority individuals selecting health careers Activities: a. Secure appropriate incentives to retain health care professionals that reflect the ethnic composition of the community b. Recruit / retain professionals of color. c. Partner with existing advisory groups working with colleges and universities to ensure that healthcare providers in training develop skills in cultural competence. Strategy 4: Decentralizing healthcare services. a. Examine the feasibility of decentralizing preventive healthcare services (including establishing new clinics), especially for the rural community, which include promotion of healthy lifestyles Activity: 17
a. Increase use of mobile health care units in rural areas Strategy 5: Economic development. a. Enhance economic development infrastructure improvement and education Activity: a. Develop a countywide autonomous group made up of health professionals, educators, city government, religious, community, and others, to determine the best mechanisms for reaching the outlined goals and objectives set for the infrastructure workgroup
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Analyzing Strengths, Weaknesses, Opportunities and Threats (SWOT)
The following exercise takes a realistic look at the strengths, weaknesses, opportunities and threats (SWOT) that you anticipate meeting as you work to reach the key objective. There are some very good reasons to do a thorough SWOT analysis and to carefully consider the results. 1. Provides a reality check to determine how practical a good idea may be, i.e., is this just `pie in the sky' or does it have a chance to go somewhere. 2. Systematically identifies factors promoting and impeding success. 3. Assesses the probability that the objective will succeed, which goes a step beyond #1. 4. Facilitates marketing to stakeholders, i.e., buy in, in-kind support, financial support. On each page, specific items you identified as strengths, weaknesses, opportunities and threats are listed and scored from 1 to 5. Each item has three scores. 1. The first score indicates how likely it is that the item will come into play as you work to reach the key objective. 2. The second score indicates how much impact the item will have on your ability to reach the key objective. 3. The third score is an average of the other two.
Probability of Success: Interpreting the Graph
The final graph shows your likelihood of success given the identified strengths, weaknesses, opportunities and threats and their estimated impact. The center of the graph where both lines cross is `0' or `no impact'. The end of each arm is `5' or `strong impact'. Each strength, weakness, opportunity and threat is represented by a numbered blue dot placed on the appropriate arm of the graph at the location of its average score. Strengths and weaknesses pull against each other on the horizontal or `X' arm of the graph. Opportunities and threats pull against each other on the vertical or `Y' arm of the graph. The averages for the horizontal (X) and vertical (Y) arms are written in the top left corner and determine the location of the pink dot. The pink dot indicates how likely your key objective is to succeed. If the pink dot is well into the upper right quadrant of the graph (between strengths and opportunities), you are highly likely to succeed in reaching your objective. If the pink dot is: (1) in the upper right quadrant but close to the X or Y line, (2) near the center of the graph, or (3) in a quadrant other than the upper right; it will probably be useful to spend more time optimizing strengths and opportunities and/or minimizing threats and weaknesses.
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Stroke Belt Elimination Initiative Infrastructure Workgroup 1 Key Objective Educate adults at risk of stroke about stroke prevention, recognizing symptoms, appropriate emergency response to stroke and blood pressure control.
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Infrastructure SWOT Analysis: Key Objective - Strengths
Strengths / Resources (internal) S1. Heart and Soul has documented success. We use this model S2. Community Health Centers (education) S3. AHA/ASA, ACS, DHEC S4. Community Action Agency, Head Start, Tri-County Black Nurses, Value Medical, MUSC, USC, S5. HBCUs, Public Schools S6. Churches (current program incl. Heart & Soul, parish nurses, Health-E-AME)
Likely 5
Impact 4
P+I / 2 4.5
2 2 2
5 4 5
3.5 3.0 3.5
2 2
5 5
3.5 3.5
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Infrastructure SWOT Analysis: Key Objective - Weaknesses
Weaknesses (internal) W1. Limited resources may not reach all the people W2. Lack of information on the best approach to education
Likely 4 4
Impact 4 4
P+I / 2 4.0 4.0
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Infrastructure SWOT Analysis: Key Objective - Opportunities
Opportunities (external) O1. May move people from inaction to action O2. Potential to reach many people in need O3. Educate elected officials to change policies and increase funding O4. Get buy-in from other community groups to finance / support education efforts O5. Build trust between community and healthcare system O6. Senior centers and Child Development Centers O7. Chamber of Commerce, Rotary, Lion's, other private, civic-minded groups Likely 3 4 2 3 4 2 2 Impact 4 3 5 4 4 5 5 P+I / 2 3.5 3.5 3.5 3.5 4.0 3.5 3.5
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Infrastructure SWOT Analysis: Key Objective - Threats
Threats (external) T1. Community groups have not agreed on educational approaches T2. Grant gets cut further T3. Community members drop out of this initiative Likely Impact P+I / 2 2 1 3 3 1 5 2.5 1.0 4.0
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SWOT: Probability of Success
S & W = X = 1.7 O & T = Y = 1.85
Objective likely to succeed
Opportunity
O5 O1-4
O6-7 S6 S5
W1 W2
S3
S2 S4
S1
Weakness
T2
Strength
T1
T3
Threat
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26
Notes
27
28
Appendices
29
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Breakout Work Sheets Session I January 28, 2005 Infrastructure Group
Infrastructure issues (seek input and identify what is important to the community, assess needs, assess barriers, gather opinions of community leaders, spiritual leaders, and elected officials, public. Determine focus, cost analysis, and develop sustainable program). I. Group Members: Infrastructure Issues 1. Debbie Bryant 2. Geneva Fleming 3. Daniel Hoskins Resource Liaison 4. Dorothy McCray 5. Michelle Sears Facilitator 6. Diane Wilson Assignment: 1. Select a group leader and a recorder. (Group leader will facilitate discussion and report results) 2. Seek to determine the following: a. Top 2 infrastructure needs (focus) b. Determine barriers to addressing top 2 needs (include how to determine cost) c. Determine ways to overcome barriers d. Determine ways to sustain alternative program 3. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a. Which agency or group will be lead for implementation, b. What person will lead this program initiative, and c. List barriers you see to moving forward. Agency: _______________________________________________________________________ Phone: [phone] Leaders Name: Dorothy McCray Barriers: _______________________________________________________________________ Intervention 1. 2. 3. Current Resources New Needed Resources
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Report Sheet (Pass in to Coordinator)
1. Select Group Leader and recorder: Dorothy McCray Group Leader John Ross Recorder 2. Seek to determine the following: A. Top 2 Infrastructure needs (focus) 1. Education / Communication (Culturally driven) 2. Economic Development (transportation, medication) B. Determine barriers to addressing top two needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1.Medication Health centers Move monies 2.Transportation Medicare 3. Cost 4. 5. 6. C. Determine ways to overcome barriers Determine barriers Identify current resources 1. Going to government officials 2.Schools education 3. 4. 5. 6. D. Determine ways to sustain alternative program Determine barriers Identify current resources 1. Government funding 2. Dental officials 3. Culture differences 4. 5. 6. Identify needed resources
Identify needed resources
3. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke Improve the school based health systems. Cultural change through education. B. Early detection and referral for hypertension and stroke The improved economy brings more health centers. The improved education - - improves physicians visits. 32
C. Promote healthy lifestyle The school-based education improves students/parents. The economic development brings medication cost. D. Enhance B/P control to 70% of treated patients The increase in money from economic development brings better resources, medication, and communication.
Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: Dorothy McCray Phone: [phone] Barriers: _______________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Intervention 1. 2. 3. Current Resources New Needed Resources
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Infrastructure Issues Work Sheet
Session II June 17, 2005
Infrastructure issues (seek input and identify what is important to the community, assess needs, assess barriers, gather opinions of community leaders, spiritual leaders, and elected officials, public. Determine focus, cost analysis, and develop sustainable program). I. Group Members: Infrastructure Issues Debbie Bryant Geneva Fleming Daniel Hoskins Resource Liaison/Recorder Dorothy McCray Group Leader Michelle Sears Diane Wilson Assignment: 1. Seek to determine the following: a. Top 2 infrastructure needs (focus) b. Determine barriers to addressing top 2 needs (include how to determine cost) c. Determine ways to overcome barriers identified in "b" d. Determine ways to sustain alternative program 2. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients 3. Determine: a.) Agency or group to be lead for directing the overall implementation of these identified strategies, b.) Determine what person from this agency will coordinate this effort, and c.) List barriers you see to moving forward.
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Report Sheet (Pass in to Coordinator)
Group Leader and Recorder: Dorothy McCray - Group Leader Daniel Hoskins - Recorder
Seek to determine the following: A. Top 2 Infrastructure needs (focus) 1. Education / Communication (health and physical education, vending machines content, community collaboration in school system) 2. Economic Development (transportation, water, sewer, medical facilities access, etc.) B. Determine barriers to addressing top two needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1.Medication (compliance 1. Health centers 1. New money gap) (centralized) 2.Transportation (over 2. Medicare (insurance 2. Decentralization of health burdensome on patients) coverage) care services. 3. Cost (percent of low3. Federal funding - CHC, 3. More effective income individuals under county works communication channels insured uninsured) (what and how to's) 4. 4. Tax base (insufficient) 4. Government facilitated employment system for welfare recipients, etc. 5. Support from service clubs (Elks, Lions, Rotary, etc.) 6. Increased supply of health professionals. 7.Expanded first response system (EMS) 5. 5. 8. Greater access to tools for testing hypertension. 1. General awareness of resources (availability and access to) 2. Will to use resources. 3. Inability to help self. 4. Lack of trust and degree of fear (from centers and community) 5. Overwhelmed by regression into condition. 6. Lack of support network (private and family). 7. Low literacy (adult and youth). 8. A degree of hopelessness due to circumstances (drop out). 9. Quality of follow up by truancy system. (load? Area?). 10. Transit nature of a percent of people. 11. Lack of respect for patients rights. 12. Trust of doctor's decision. 13. Patient/provider communication gap (openness). 14. Stigma attached to community health care center (confidentiality factor of non privacy in the community) Specific barrier concerning school system use of vending machines. 1. Quality of vending machines content. 2. Economics (income for schools in making up short funds from school district. 3. Infiltration of fast food venders. 35
4. 5. 6. 7.
Lack of true concern for health (school board/school district). Lack of control in learning quality decision making Food preparation methods may be lacking in quality. Lack of collaborative cooperation (parents, school, school board, agencies, community groups (churches).
Specific barrier Physical education 1. Stopped by school district and school board as mandatory. 2. Returned as an elective course. 3. Not a required course earlier (elementary, middle, high school). 4. Lack of knowledge of use of recess and structured P.E. 5. Lack of encouragement by counties to be physically active. 6. Environment does not encourage physical activity. 7. Provider reinforcement of need for physical activity (influence the taking of action). 8. Lack of knowledge and motivation to except responsibility to establish ministries (organizations to bring about solutions). C. Determine ways to overcome barriers Determine barriers to Identify current resources overcoming barriers determined in "B" 1. Going to government 1. Community leaders, officials/redirection of funds church groups 2.School based health 2.Community Health Centers education (mandatory daily) 3. Public and private schools 4. Legislators, health professionals and educators. 5. Health agencies (DHEC, ACS, AHA, etc.) 6. Local and state private funding sources 3. Reviewing of Charter Schools concept and their impact on public school funding. 4.Sustaining the presence of permanent health care facilities in rural areas Identify needed resources 1. Mobile health care unit (s) 2. Stronger advocates in key decision making positions 3. More partnering (public and private sector)
Possible solution: Create jobs program for welfare and low-income families Provided and managed by the state to build into county infrastructure for health and economic development. D. Determine ways to sustain alternative program Determine barriers Identify current resources 1. Funding 1. Federal, State, and local tax base 2. Total health care facilities 3. Cultural competency 2. Private funding sources and education lottery 3. School system 36
Identify needed resources 1. Activation of independent advocacy for reallocation of current funds and for the identification of new funds 2. Increased health education for youth and seniors 3. Structured curricula and
administration
communication of community needs that increases cultural competency among leaders. (health, education, legislators, with follow-up for compliance and impact. (non threatening with an avoidance of head on confrontation if possible,)
4.Health and physical education mandated by school system and government 5.
4. Senior center services (food, clothing, etc.) 5.Higher education institutions (MUSC, USC, HBCUs, etc.) continuing medical education and other continuing education opportunities
Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke 1. Improve the school based health systems (awareness of cause and effect). 2. Cultural change through education. B. Early detection and referral for hypertension and stroke 1. Improved economic development brings more interaction with the health care system. 2. Improved education - improves physicians/patient relationships. C. Promote healthy lifestyle 1. Improved school-based health and physical education improves students, parents, and school official's attitudes and behavior towards a healthier lifestyle. 2. Improved economic development increases a person's ability to afford and be involved in total health care. D. Enhance B/P control to 70% of treated patients An increase in awareness and income from education and economic development brings better resources and the ability to comply. Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: It is recommended that: A state wide agency, autonomous to the health care, school or government system be recruited to pursue these strategies. (National Baptist Deacons Convention SC chapters, African Methodist Episcopal Church 7th Episcopal District, etc.) Leaders Name: Dorothy McCray Barriers: Recruitment of such an agency.
37
Infrastructure Workgroup Session III August, 12 2005
Goal
Seek input and identify what is important to the community as related to stroke prevention.
Objective
Increase health education for seniors at risk
Objective
Expand the number of those at risk who have the tools for testing hypertension.
Objective
Expand first response teams to reach victims sooner and take them to a health facility that treats stroke.
Objective
Create an effective communication system related to stroke prevention.
Objective
Increase supply of health care professionals that reflect makeup of the community served. Strategy Activity Start Date: End Date: Secure funds to retain health care professionals that reflect educational background. Activity Start Date: End Date: Partner with colleges and universities and provide ongoing support and a commitment to health care providers to enhance their skills.
Objective
Increase health education for youth. Strategy Activity Start Date: End Date: Encourage schools to add a health component as well as physical education to become more aware of the causes of stroke and encourage healthier lifestyle choice.
Objective
Decentralize health care services to further decentralize in rural areas. Strategy Activity Start Date: End Date: Increase number of mobile health care units in rural areas.
Objective
Enhance economic development infrastructure improvement and education. Strategy Develop a countywide autonomous group made up of health, educators, city government, religious community, and others, to determine the best mechanisms for reaching the outlined goals and objectives set for the infrastructure workgroup.
38
Stroke Belt Elimination Initiative Community Action Team Plan
Workgroup 2: Education & Awareness
Mission: Support culturally appropriate community education on stroke risk, prevention, symptoms, screening, and referral. Key Objective: Identify and develop, where appropriate, tools to raise awareness and educate community members of all ages, genders, and educational levels.
Strategy 1: Stroke Elimination Through Culturally Appropriate Tools a. Assess what culturally appropriate tools currently exist in the 4-county areas on stroke prevention, education, screening, etc. signs and symptoms of stroke, blood pressure basics, results of uncontrolled blood pressure, 911, medications including thrombolytic therapy. Access to medications and patient assistance programs. i. Minimize use of printed brochures. Those used should be culturally appropriate and written at reading levels of participants. ii. Maximize use of simplified video teaching tape modules. Activities: a. Compile list of resources offered through the follow sources i. Hospital community education and outreach ii. DHEC, community health centers, pharmaceutical companies, iii. Programs, faith groups, senior centers, schools, and agencies health programs iv. Internet b. Compile eligibility criteria, target audience, cost, contact person and application process c. Develop method of disseminating information to residents of 4 county target area i. Media ii. Onsite iii. Computer list-serve d. Determine method of disseminating information to SBEI partners i. SBEI meetings ii. Meetings sponsored by SBEI partners iii. SBEI List-serve iv. Telephone e. Establish timeframe and benchmarks f. Evaluate results
Strategy 2: Stroke Elimination Through Train the Trainer Models a. Develop, or adopt and conduct train the trainer models to provide stroke prevention education on the following topics Activities: a. Get approval to use American Heart Association, SBEI Train the Trainer and other models; b. Determine persons who will recruit trainee and venue i. Senior centers 39
c. d.
e. f.
ii. Faith groups Conduct training session Determine method of disseminating information to SBEI partners i. SBEI meetings ii. Meetings sponsored by SBEI partners iii. SBEI List-serve iv. Telephone Establish timeframe and benchmarks Evaluate results
Strategy 3: Stroke Elimination Through Eliminating Barriers and Closing Gaps a. Identify the gaps and barriers to understanding stroke information. Activities: a. Compile list of barriers and gaps identified by researchers, the SBEI partners, providers, CDC, NIH, DHEC data b. Determine what barrier(s) can be addressed and net greatest, demonstrable, benefits c. Determine what services SBEI partners are providing and how their work can be enhanced by collaborating with SBEI partners i. Collect 1 page profile of each program ii. Develop a calendar of program events that shows target audience and goals d. Determine method of disseminating information to SBEI partners i SBEI meetings ii. Meetings sponsored by SBEI partners iii. SBEI list-serve iv. Telephone e. Establish timeframe and benchmarks f. Evaluate results
Strategy 4: Stroke Elimination Through Existing Model and Methods a. Adopt approved manipulative, interactive teaching models from SBEI partners, local and national health care entities b. Administer pre and post tests to measure knowledge acquired c. Survey participants to determine how knowledge will be used Activities: a. Establish a process to and designate persons to collect model from the following programs i. MUSC College of Nursing clogged arteries ii. National Heart Lung, and Blood Institute DASH diet plan iii. National Heart, Lung, and Blood Institute model for lowering blood pressure iv. Stroke Belt Elimination Initiative Dash for Good Health Southern Style cookbook, audio visual programs, etc. v. Heart & Soul `Salt 099' vi. FAST method for determine if someone has suffered a stroke b. Develop a strategy for teaching SBEI partners and other presenters how to use models i. Develop a system of creating opportunities to teach participant base for SBEI Partners ii. Senior centers iii. Community centers iv. Family reunions v. Schools vi. Faith, civic and social organizations 40
vii. Health care workers c. Determine method of disseminating information to SBEI partners i. SBEI meetings ii. Meetings sponsored by SBEI partners iii. SEBI list-serve iv. Telephone v. Establish timeframe and benchmarks vi. Evaluate results
Strategy 5: Stroke Prevention Through Incentives to Participate a. Develop a storehouse of appropriate incentives a system for rewarding and recognizing successful participants and SEBI Partners Activities: a. Partner with pharmaceutical companies and hospitals b. Grants for SBEI partners to purchase incentives c. Host recognition programs in each county d. Highlight success through media coverage e. Develop and use logo on billboards and all materials
41
Analyzing Strengths, Weaknesses, Opportunities and Threats (SWOT)
The following exercise takes a realistic look at the strengths, weaknesses, opportunities and threats (SWOT) that you anticipate meeting as you work to reach the key objective. There are some very good reasons to do a thorough SWOT analysis and to carefully consider the results. 1. Provides a reality check to determine how practical a good idea may be, i.e., is this just `pie in the sky' or does it have a chance to go somewhere. 2. Systematically identifies factors promoting and impeding success. 3. Assesses the probability that the objective will succeed, which goes a step beyond #1. 4. Facilitates marketing to stakeholders, i.e., buy in, in-kind support, financial support. On each page, specific items you identified as strengths, weaknesses, opportunities and threats are listed and scored from 1 to 5. Each item has three scores. 1. The first score indicates how likely it is that the item will come into play as you work to reach the key objective. 2. The second score indicates how much impact the item will have on your ability to reach the key objective. 3. The third score is an average of the other two.
Probability of Success: Interpreting the Graph
The final graph shows your likelihood of success given the identified strengths, weaknesses, opportunities and threats and their estimated impact. The center of the graph where both lines cross is `0' or `no impact'. The end of each arm is `5' or `strong impact'. Each strength, weakness, opportunity and threat is represented by a numbered blue dot placed on the appropriate arm of the graph at the location of its average score. Strengths and weaknesses pull against each other on the horizontal or `X' arm of the graph. Opportunities and threats pull against each other on the vertical or `Y' arm of the graph. The averages for the horizontal (X) and vertical (Y) arms are written in the top left corner and determine the location of the pink dot. The pink dot indicates how likely your key objective is to succeed. If the pink dot is well into the upper right quadrant of the graph (between strengths and opportunities), you are highly likely to succeed in reaching your objective. If the pink dot is: (1) in the upper right quadrant but close to the X or Y line, (2) near the center of the graph, or (3) in a quadrant other than the upper right; it will probably be useful to spend more time optimizing strengths and opportunities and/or minimizing threats and weaknesses.
42
Stroke Belt Elimination Initiative Education & Awareness: Workgroup 2
Key Objective Identify and develop, where appropriate, tools to raise awareness and educate community members of all ages, genders, and educational levels.
43
Education & Awareness SWOT Analysis: Key Objective - Strengths
Strengths/Resources (internal) S1. Comprehensive in its approach S2. Community Health Centers (education) S3. AHA/ASA, ACS, DHEC, DSS, USDA, HUD, Trident United Way, SCPHCA, Hospitals, DHHS, AHEC S4. SCAHSA, Head Start, Tri-County Black Nurses, Value Medical S5. MUSC, USC, HBCUs, Public Schools S6. Churches (current program incl. Heart & Soul, parish nurses, Health-E-AME) S7. Community Development Corporation Likely Impact P+I / 2 3 2 2 5 5 4 4 3.5 3.0
2 2 2 2
5 5 5 5
3.5 3.5 3.5 3.5
44
Education & Awareness SWOT Analysis: Key Objective - Weaknesses
Weaknesses (internal) W1. Not enough volunteers to work evenings and weekends W2. Insufficient integration and management of existing resources
Likely Impact P+I / 2 4 4 4
5
4
4.5
45
Education & Awareness SWOT Analysis: Key Objective - Opportunities
Opportunities (external) O1. Identify volunteers and new leaders in stroke prevention O2. Form new partnerships with communities O3. Great potential to reach many people in need O4. Inclusive of everyone of all demographic groups Likely Impact P+I / 2 3 5 4 5 5 5 5 5 4 5 4.5 5
46
Education & Awareness SWOT Analysis: Key Objective - Threats
Threats (external) T1. Potentially funding cuts reduce resources T2. Failure to get community buy in T3. Lack advocacy to deliver resources to people in need
Likely Impact P+I / 2 1 3 4 2 5 4 1.5 4 4
47
SWOT: Probability of Success
S & W = X = 1.7 O & T = Y = 1.85
Objective likely to succeed
Opportunity
O2 O3 O1 O4
S4-7 W2 W1 S3 S2 T1 S1
Weakness
Strength
T2-3
Threat
48
Notes
49
50
Appendices
51
52
Breakout Work Sheet Session I January 28, 2005 Education & Awareness Group
Education & Awareness (consider culture of individuals, review available tools and resources, develop tools, determine method of distribution, tailor message for community, delivery of message, create speakers bureau, assess barriers, create a budget, and develop realistic and sustainable programs). I. Group Members: Education & Awareness 1. R. Delores Gibbs 2. Pearl Edwards 3. Virginia Milton 4. Rosetta Swinton Resource Person 5. Betsy Whaley Facilitator 6. Carrie Whipper 7. David Rivers 8. Glenn Fleming Assignment: 1. Select a group leader and a recorder. (Group leader will facilitate discussion and report results) 2. Seek to determine the following: a. Top 3 barriers to address that hinder access to education (focus) b. Determine barriers to addressing these barriers (include how to determine cost) c. Determine ways to overcome barriers d. Determine ways to sustain alternative program 3. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a. Which agency (s) or group (s) will be lead for implementation, b. Identify what person will lead this program initiative, and c. List barriers you see to moving forward. Agency: Palmetto Project Phone: [phone] Leaders Name: Steven Skardon Barriers: ____________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________ Intervention Current Resources New Needed Resources 1. Literacy 2. Awareness of needs 3. Access to info / resources
53
Report Sheet (Pass in to Coordinator)
1. Select Group Leader and recorder: ____________________________________ 2. Seek to determine the following: A. Top 3 barriers to address that hinder access to education (focus) 1. Literacy 2. Awareness of needs 3. Access to resources and information B. Determine barriers to addressing top three needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1. Inappropriate media 2. Poverty 3. Messenger /trust factor 4. Literacy 5. 6. C. Determine ways to overcome barriers Determine barriers Identify current resources 1.Inappropriate media 2. Poverty - global 3. Messenger traditional medicine, genuine, community driven 4. Literacy - global 5. 6. D. Determine ways to sustain alternative program Determine barriers Identify current resources 1.Community needs to buy into and incorporate into community values 2. 3. 4. 5. 6. Identify needed resources
Identify needed resources
Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke i. Community ownership 54
B. Early detection and referral for hypertension and stroke ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ C. Promote healthy lifestyle ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ D. Enhance B/P control to 70% of treated patients ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ Determine: a). Which agency or group will be lead for implementation b). What person will lead this program initiative and c). List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: ___________________________________Phone: ________________________ Barriers: ______________________________________________________________________________ Intervention 1. 2. 3. Current Resources New Needed Resources
55
Education & Awareness Work Sheet
Session II June 17, 2005
Education & Awareness (consider culture of individuals, review available tools and resources, develop tools, determine method of distribution, tailor message for community, delivery of message, create speakers bureau, assess barriers, create a budget, and develop realistic and sustainable programs). I. Group Members: Education & Awareness R. Delores Gibbs Pearl Edwards Virginia Milton Rosetta Swinton Resource Liaison Betsy Whaley Carrie Whipper Group Leader Daniel Hoskins Recorder Assignment: 1. Seek to determine the following: a. Top 3 barriers to address that hinder access to education (focus) b. Determine barriers to addressing these barriers (include how to determine cost) c. Determine ways to overcome barriers identified in "b" d. Determine ways to sustain alternative program 2. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a.) Which agency (s) or group (s) will be lead for implementation, b.) Identify what person will lead this program initiative, and c.) List barriers you see to moving forward.
56
Report Sheet (Pass in to Coordinator) Group Leader and Recorder: Carrie Whipper Group Leader Seek to determine the following: A. Top 3 barriers to address that hinder access to education (focus) 1. Literacy/poverty 2. Awareness of needs (cause and effect) 3. Access to resources and information (consistent availability) appropriated forum B. Determine barriers to addressing top three needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1. Inappropriate media-costDHEC, ACS, AHA, ALA, 1. Inclusion of local people in design mortality-morbidity-disability CDC&P process for all media 2. Poverty (decrease the SCAHSA, SCPHCA, DSS, 2. Job, local government, flanking impact) CDC, SSI political strategy 3. Messenger /trust factor MUSC, HBCUs, USC, etc. 3. Better balance in volunteer -vscompensated help (religious groups and other organizations. 4. Literacy (expanded) Trident United Way and State 4. A sensitive search and screening Department of Education process C. Determine ways to overcome barriers Determine barriers to Identify current resources overcoming barriers determined in "B" 1.Time, resources availability DHEC, ACS, AHA, ALA, and access on part of CDC&P, Local Churches community residents 2. Availability of services to address jobs and preparation for work (lack of advocacy for this type service from the community, business community and community organizations) 3. Cost of compensation and resistance of public 4. Receptiveness of the responsible resource agencies SCAHSA, SCPHCA, DSS, CDC, SSI, HUD, USDA, Local Churches Identify needed resources 1. Vouchers, gratuity, stipend, other incentives. Create ownership environment for community participation 2. Maximize use of current resources and recognition for agencies (resource). Provide success stories, increase shadowing /mentoring opportunities. 3. Advocacy for self evaluation by resource agencies as it relate to impact on their constituencies. 4. User friendly presentation of facts on literacy and its impact on Hypertension and stroke. Identify needed resources Collaborative development, adoption and ownership by current local and state agencies and groups Daniel Hoskins Recorder
SCAHSA, SCPHCA, DSS, CDC, SSI, HUD, USDA, Local Churches SCAHSA, SCPHCA, DSS, CDC, SSI, HUD, USDA, Local Churches
D. Determine ways to sustain alternative program Determine barriers Identify resources current 1.Lack of community buy in to Ongoing efforts of community program and its ability to groups (CAAs, CHC, Head incorporate community values Start, etc) 57
Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke Community ownership (access to current and exposure to technology on constant basis in forums that are natural) B. Early detection and referral for hypertension and stroke Knowledge and increased access opportunities should lead to action. C. Promote healthy lifestyle Knowledge and increased access opportunities should lead to action. D. Enhance B/P control to 70% of treated patients Knowledge and increased access opportunities should lead to action. Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: Palmetto Project - Steven Skardon Leaders Name: Carrie Whipper Barriers:
58
Education and Awareness Workgroup Session III August 12, 2005
Goal
Education and Awareness Workgroup Support culturally appropriate community education on stroke risk, prevention, symptoms, screening, and referral among African Americans.
Objective
Develop tools Develop appropriate tools to raise awareness and educate community members of all ages, genders, and educational levels. Strategy Reach all segments of the community with education messages Identify barriers to understanding information on stroke and take these into consideration in developing educational programs. Spread education to everyone, where they live, pray, work, learn, etc. Advocate on behalf of those who do not have access to information. Threat Likelihood: 1 Potential for funding cuts reduces resources Threat Likelihood: 3 Failure to get community buyin Opportunity Likelihood: 3 Identify volunteers and new leaders in stroke prevention Strength Likelihood: 4 Have great potential to reach many people in need Weakness Likelihood: 4 Not enough volunteers to work on weekends Strength Likelihood: 5 Inclusive of everyone Strength Likelihood: 5 comprehensive in its approach Weakness Likelihood: 5 Insufficient resources to provide everything needed Opportunity Likelihood: 5 Form new partnerships with communities Impact: 2 Impact: 5 Impact: 5 Impact: 5 Impact: 4 Impact: 5 Impact: 5 Impact: 4 Impact: 5
59
60
Stroke Belt Elimination Initiative Community Action Team Plan
Workgroup 3: Lifestyle Intervention
Mission: Promote good nutrition and physical activity. Key Objective: Develop sustainable culturally-sensitive tools to enhance adoption of healthy lifestyle themes in the community.
Strategy 1: Education a. Gather input from community, leadership team and research b. Evaluate and develop tools, where appropriate, based on input from the community, leadership team and utilize tools with documented effectiveness. This will lead to better methods to inform the public about stroke prevention. Activities: a. Host community forums with tools available for their input b. Review scientific literature to identify effective tools c. Advisory team meetings to review tools d. Meeting of Leadership Team to review tools
Strategy 2: Community priorities and expectations a. Identify expectations of the community and the funding agency to prioritize the activities for each community b. Seek input from community and grantee to reach consensus c. Develop consensus on priorities leading to awareness of stroke prevention and enhancing buy-in from all partners in order to increase chances of sustainability Activities: a. County Action (Leadership) Team to meet with community members in each county. Seek input and provide feedback to leadership group and community members b. Prepare Memorandum of Understanding (MOU) for each county action team outlining consensus i. MOU outlines community expectations such as resources, planning of activities, etc. and expectations of grant for community participation like volunteers for training, speakers, etc. for each local community action team. This is ongoing.
Strategy 3: Community interventions a. Tailor community interventions such as health information, DASH cookbook, videos, etc. Activities: a. Test the effectiveness of tools i. Pre-test with a group of community people ii. Pre-test for cultural sensitivity and meaning b. Promote healthy lifestyles through more effective tools c. Test the knowledge of the community about stroke d. Identify community events in which to use tools
61
Analyzing Strengths, Weaknesses, Opportunities and Threats (SWOT)
The following exercise takes a realistic look at the strengths, weaknesses, opportunities and threats (SWOT) that you anticipate meeting as you work to reach the key objective. There are some very good reasons to do a thorough SWOT analysis and to carefully consider the results. 1. Provides a reality check to determine how practical a good idea may be, i.e., is this just `pie in the sky' or does it have a chance to go somewhere. 2. Systematically identifies factors promoting and impeding success. 3. Assesses the probability that the objective will succeed, which goes a step beyond #1. 4. Facilitates marketing to stakeholders, i.e., buy in, in-kind support, financial support. On each page, specific items you identified as strengths, weaknesses, opportunities and threats are listed and scored from 1 to 5. Each item has three scores. 1. The first score indicates how likely it is that the item will come into play as you work to reach the key objective. 2. The second score indicates how much impact the item will have on your ability to reach the key objective. 3. The third score is an average of the other two.
Probability of Success: Interpreting the Graph
The final graph shows your likelihood of success given the identified strengths, weaknesses, opportunities and threats and their estimated impact. The center of the graph where both lines cross is `0' or `no impact'. The end of each arm is `5' or `strong impact'. Each strength, weakness, opportunity and threat is represented by a numbered blue dot placed on the appropriate arm of the graph at the location of its average score. Strengths and weaknesses pull against each other on the horizontal or `X' arm of the graph. Opportunities and threats pull against each other on the vertical or `Y' arm of the graph. The averages for the horizontal (X) and vertical (Y) arms are written in the top left corner and determine the location of the pink dot. The pink dot indicates how likely your key objective is to succeed. If the pink dot is well into the upper right quadrant of the graph (between strengths and opportunities), you are highly likely to succeed in reaching your objective. If the pink dot is: (1) in the upper right quadrant but close to the X or Y line, (2) near the center of the graph, or (3) in a quadrant other than the upper right; it will probably be useful to spend more time optimizing strengths and opportunities and/or minimizing threats and weaknesses.
62
Stroke Belt Elimination Initiative Lifestyle Intervention Workgroup 3 Key Objective Develop sustainable, culturallysensitive tools to enhance adoption of healthy lifestyle themes in the community.
63
Lifestyle Intervention SWOT Analysis: Key Objective - Strengths
Strengths / Resources (internal) S1. Broad representation reviewing tools S2. Community Health Centers (education) S3. AHA/ASA, ACS, DHEC, DSS, USDA, HUD, Trident United Way, SCPHCA, Hospitals, DHHS S4. SCAHSA, Head Start, Tri-County Black Nurses, Value Medical S5. MUSC, USC, HBCUs, Public Schools S6. Churches (current program incl. Heart & Soul, parish nurses, Health-E-AME) S7. Community Development Corporation Likely 5 2 2 Impact 5 5 4 P+I / 2 5 3.5 3.0
2
5
3.5
2 2
5 5
3.5 3.5
2
5
3.5
64
Lifestyle Intervention SWOT Analysis: Key Objective - Weaknesses
Weaknesses (internal) W1. Suboptimal integration of resources across agencies W2. Impatience (people want to see it now) W3. Time consuming for group to deliver message to target audience
Likely Impact P+I / 2 3 4 4 4 4 4 3.5 4 4
65
Lifestyle Intervention SWOT Analysis: Key Objective - Opportunities
Opportunities (external) O1. Identify new ideas and novel programs O2. New ideas can lead to new funding Likely Impact 3 3 5 5 P+I / 2 4 4
O3. Develop improved tools that are more effective
4
4
4
O4. The tools and approach have the potential to gain trust of everyone O5. Opportunity to share effective tools
4
5
4.5
5
5
5
66
Lifestyle Intervention SWOT Analysis: Key Objective - Threats
Threats (external) T1. Loss of funding leads to potential lack of trust T2. Lack of buy-in from the community
Likely Impact P+I / 2 1 2 1 5 1 3.5
T3. Unresolved conflict due to unmet expectations T4. Cannot satisfy everyone T5. Very time consuming
3 3 5
5 3 5
4 3 5
67
SWOT: Probability of Success
S & W = X = 1.4 O & T = Y = 0.5
Objective likely to succeed
Opportunity
O5 O4 O1-3
W1 W2-3
S4-7 S3 T1 S23 S1
Weakness
Strength
T4 T2 T3 T5
Threat
68
Notes
69
70
Appendices
71
72
Breakout Work Sheet Session I January 28, 2005 Lifestyle Intervention Group
Lifestyle Intervention, a. Nutrition, b. Exercise (develop sustainable cultural sensitive tools, tailor intervention for the community, select priorities, consider community expectations, develop an effective message regarding program's expectations, food and exercise forums/fairs, reasonable exercise program that include activities for all age group, create a budget, develop sustainable programs). Group Members: Lifestyle Intervention a. Nutrition b. Exercise 1. Jeannette Jordan Resource Person 2. Charles Kilgore Facilitator 3. Roberta Pinckney 4. John Simkovich 5. Carrie Houser James 6. Karen Hill 7. Cecil Diggs 8. Leonard Davis Assignment: 1. Select a group leader and a recorder. (Group leader will facilitate discussion and report results) I. 2. Seek to determine the following: a. Educational data or information lacking among African American population (focus) b. Determine barriers to overcoming identified lacking (include how to determine cost) c. Determine ways to overcome barriers d. Determine ways to sustain alternative program 3. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a. Which agency or group will be lead for implementation, b. What person will lead this program initiative, and c. List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: ___________________________________Phone: ________________________ Barriers: _______________________________________________________________________ Intervention Current Resources New Needed Resources 1. 2. 3.
73
Report Sheet (Pass in to Coordinator)
1. Select Group Leader and recorder: 2. Seek to determine the following: Charles Kilgore - Group Leader Carrie Houser James - Recorder
A. Educational data or information lacking among African American population (focus). 1. Understanding of the relationship between lifestyle, health, and nutrition. 2. Appreciation and value of health messages. B. Determine barriers to addressing top two needs 9 (include how to determine cost)
Determine barriers Identify current resources Identify needed resources
1. Myths 2. "Madison Ave" Advertising 3. Irrelevant Methodologies 4. Disassociation from health message 5. Overcoming habits 6. Cultural values C. Determine ways to overcome barriers
Determine barriers Identify current resources Identify needed resources
1. Speaking at eh level of audience 2. Dispelling myths not offending 3. Reinforcement of behavior changes - - rewards 4. Interaction ? education experience - - rewards 5. Increase awareness of health lifestyle ?? 6. D. Determine ways to sustain alternative program
Determine barriers Identify current resources Identify needed resources
1. Partnership with community agencies 2. 3. 4. 5. 6. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke ________________________________________________________________________________________ ________________________________________________________________________________________ 74
____________________________ B. Early detection and referral for hypertension and stroke ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ C. Promote healthy lifestyle ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ D. Enhance B/P control to 70% of treated patients ________________________________________________________________________________________ ________________________________________________________________________________________ ____________________________ Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: ___________________________________Phone: ________________________ Barriers: ______________________________________________________________________ _____________________________________________________________________________ Intervention 1. 2. 3. Current Resources New Needed Resources
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Lifestyle Intervention Work Sheet
Session II June 17, 2005
Lifestyle Intervention: a. Nutrition, b. Exercise (develop sustainable cultural sensitive tools, tailor intervention for the community, select priorities, consider community expectations, develop an effective message regarding program's expectations, food and exercise forums/fairs, reasonable exercise program that include activities for all age group, create a budget, develop sustainable programs). I. Group Members: Lifestyle Intervention Jeannette Jordan Charles Kilgore Roberta Pinckney John Simkovich Carrie James Karen Hill Cecil Diggs Daniel Hoskins Resource Liaison Group Leader
Recorder
Assignment: 1. Seek to determine the following: a. Educational data or information lacking among African American population (focus) b. Determine barriers to overcoming identified lacking (include how to determine cost) c. Determine ways to overcome barriers identified in "b" d. Determine ways to sustain alternative program 2. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a.) Which agency or group will be lead for implementation, b.) What person will lead this program initiative, and c.) List barriers you see to moving forward.
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Report Sheet (Pass in to Coordinator)
Group Leader and Recorder: Charles Kilgore - Group Leader Daniel Hoskins Recorder Seek to determine the following: A. Educational data or information lacking among African American population (focus). 1. Understanding of the relationship between lifestyle, health, and good nutrition. 2. The lack of appreciation and value of health messages B. Determine barriers to addressing top two needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1. Deceptive "Madison Ave." 1. One on one counseling 1. Packaging of messages in advertising that lead to the Provider/patient. different ways and in different formation of Myths, Habits, 2. Specialty Intercession places. 2. Flanking strategies and values (health education, literature, (avoid head on attacks). 3. promotion) 3. Agencies Messages of association with (DHEC, SCPHCA, SCAHSA, targeted theme etc.) 4.Research KAPB, clinical, basic (continuing) 2. Traditional methodologies that have led to disassociation from health messages and messengers C. Determine ways to overcome barriers Determine barriers to Identify current resources overcoming barriers determined in "B" 1. Speaking on and to the 1. Media (all) concerns of audience 2.Community Health clinics and health care agencies (AHA, ALA, ACS, DHEC, etc.) 2. Dispelling myths without 3. Local business. offending 4. Chamber of Commerce 5. Small businesses (mom & pop) 3. Changing attitudes towards 6. Community health themes changing ones behavior (special month programs) ie, rewards (appropriate Community of Character) incentives) 4. Interaction of educational experience - - rewards 5. Increase awareness of the why of making health lifestyle choices D. Determine ways to sustain alternative program Determine barriers Identify current resources 1. Partnering with community 1. Agencies (health and 77 Identify needed resources 1. Better relationships with existing resource agencies. a. Business b. Health c. Research d. Advertisement e. Schools (public, private, preschool up)
Identify needed resources 1. Consideration of incentive
agencies (business, health, etc.) 2. Maximize involvement of the community in incentive offerings. 3. Employ offerings such as percentage rate reductions in insurances (health, auto, life
business) 2. Community Health Centers.
programs that provide motivation 2. Consideration of incentives that motivate, ie pharmacy discounts etc.
Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke: May revolutionize methods used to education the public about the risks of hypertension, stroke and possibly other diseases B. Early detection and referral for hypertension and stroke: Incentive initiative should increase the frequency of early detection and sustain preventive practices. C. Promote healthy lifestyle Increased awareness and identification with the why of selected health care practices being promoted, should create greater personal involvement of individuals in maintaining the quality of their health D. Enhance B/P control to 70% of treated patients Should increase conscious effort to maintain control of BP, BMI, and screening practices. Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: It was recommended that: 1. Vorhees College be approached to establish a partnership in undertaking the implementation of these strategies. (Contact Leroy Davis, PhD. Tracking System) 2. SCSU in collaboration with Claflin University through its extension program be considered. 3. The Regional Medical Center of Orangeburg and Calhoun Counties, (Ms. Brenda Williams, Risk & Safety program also be considered. 4. That possibly a collaboration with all four institutions might be pursued. Leaders Name: Charles Kilgore, MD Barriers: Directives that may exist for current funds available (Vorhees College)
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Lifestyle Intervention Session III August12, 2005
Goal
Lifestyle Intervention Workgroup This workgroup focuses on promoting nutrition and physical activity.
Objective
Develop sustainable culturally-sensitive tools Develop sustainable culturally-sensitive tools to enhance adoption of healthy lifestyle themes in the community. Strategy Gather input from community, leadership team and research Develop tools based on input from the community, leadership team and tools with documented effectiveness. This will lead to better methods to inform the public about stroke prevention. Threat Likelihood: 2 Lack of buy in from the community with same message Weakness Likelihood: 3 Cannot satisfy everyone Threat Likelihood: 3 Unresolved conflict due to not meeting expectations Opportunity Likelihood: 4 New ideas can lead to new funding Threat Likelihood: 4 Loss of funding leads to potential lack of trust Strength Likelihood: 5 broad representation reviewing tools Strength Likelihood: 5 Has potential to gain trust of everyone Strength Likelihood: 5 Opportunity to share effective tools with everyone Weakness Likelihood: 5 Very time consuming Opportunity Likelihood: 5 Develop improved tools that are more effective Opportunity Likelihood: 5 Identify new ideas and novel programs Impact: 5 Impact: 3 Impact: 5 Impact: 5 Impact: 4 Impact: 5 Impact: 5 Impact: 5 Impact: 5 Impact: 5 Impact: 5
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Stroke Belt Elimination Initiative Community Action Team Plan
Workgroup 4: Access to Care & Medications
Mission: Assess barriers, create models and methods for addressing or removing barriers, identify resources for transportation and medication assistant programs, create resource manual, and create sustainable programs. Key Objective: Identify and engage community resources that overcome barriers to affordability as well as lack of education, transportation, medical home, patient buy-in, and support systems.
Strategy 1: Education and access to care a. Define strategies to identify needs and address them b. Identify needs and resources to maximize access to a medical home, receive effective education, and support systems including transportation. Activities: a. Coordinate alternative forms of transportation such as RTMA, Medicaid buses, church vans, car pools and family assistance, etc. b. Develop resource models. Appropriately identify and link medical and pharmaceutical resources to target communities Community Health Centers (CHCs) and free clinics, etc. c. Develop a resource manual. Identify CHCs, free clinics, local, county and federal administration prescription drug programs, drug companies, and other support services d. Improve information management and coordination to reduce inefficient use of resources and services. e. Improve communication and trust through continuing medical education, and ongoing in-service programs for all relevant community agencies f. Teach patients to be more assertive in the office setting regarding their need for stroke prevention and treatment through activities such as preparing questions before the visit and role modeling g. Help patient identify family members, neighbors, churches and other community resources to assist with transportation to appointments and to assist patients in understanding and implementing medical instructions h. Educate public on how to access and utilize drug resources, coordinate alternative services, utilize volunteers, teach providers or volunteers to repeat instructions, and use health ministries to educate patients about resources i. Educate elected officials regarding lack of access to prescription drugs and a medical home, hold community forums, etc.
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Analyzing Strengths, Weaknesses, Opportunities and Threats (SWOT)
The following exercise takes a realistic look at the strengths, weaknesses, opportunities and threats (SWOT) that you anticipate meeting as you work to reach the key objective. There are some very good reasons to do a thorough SWOT analysis and to carefully consider the results. 1. Provides a reality check to determine how practical a good idea may be, i.e., is this just `pie in the sky' or does it have a chance to go somewhere. 2. Systematically identifies factors promoting and impeding success. 3. Assesses the probability that the objective will succeed, which goes a step beyond #1. 4. Facilitates marketing to stakeholders, i.e., buy in, in-kind support, financial support. On each page, specific items you identified as strengths, weaknesses, opportunities and threats are listed and scored from 1 to 5. Each item has three scores. 1. The first score indicates how likely it is that the item will come into play as you work to reach the key objective. 2. The second score indicates how much impact the item will have on your ability to reach the key objective. 3. The third score is an average of the other two.
Probability of Success: Interpreting the Graph
The final graph shows your likelihood of success given the identified strengths, weaknesses, opportunities and threats and their estimated impact. The center of the graph where both lines cross is `0' or `no impact'. The end of each arm is `5' or `strong impact'. Each strength, weakness, opportunity and threat is represented by a numbered blue dot placed on the appropriate arm of the graph at the location of its average score. Strengths and weaknesses pull against each other on the horizontal or `X' arm of the graph. Opportunities and threats pull against each other on the vertical or `Y' arm of the graph. The averages for the horizontal (X) and vertical (Y) arms are written in the top left corner and determine the location of the pink dot. The pink dot indicates how likely your key objective is to succeed. If the pink dot is well into the upper right quadrant of the graph (between strengths and opportunities), you are highly likely to succeed in reaching your objective. If the pink dot is: (1) in the upper right quadrant but close to the X or Y line, (2) near the center of the graph, or (3) in a quadrant other than the upper right; it will probably be useful to spend more time optimizing strengths and opportunities and/or minimizing threats and weaknesses.
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Stroke Belt Elimination Initiative Access to Care & Meds: Workgroup 4
Key Objective Identify and engage community resources that overcome barriers to affordability as well as lack of education, transportation, medical home, patient buy-in, and support systems.
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Access to Care & Meds SWOT Analysis: Key Objective - Strengths
Strengths / Resources (internal) S1. Comprehensive in approach S2. Community health centers, free clinics, local county, state & federal administration
Likely Impact P+I / 2 3 4 5 5 4 4.5
S3. Prescription drug programs and resource utilization guides
4
5
4.5
S4. Transportation resources (i.e., RTMA, church vans etc.)
2
5
3.5
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Access to Care and Meds SWOT Analysis: Key Objective - Weaknesses
Weaknesses (internal) W1. Lack of specificity in how to implement activities Likely Impact P+I / 2 3 4 3.5
W2. Time consuming for group to deliver resource guides to target audience
3
3
3
W3. Overcome territorial issues and trust
4
5
4.5
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Access to Care and Meds SWOT Analysis: Key Objective - Opportunities
Opportunities (external) O1. Public school clinics O2. Develop coordinated system that works O3. Improve dialogue among agencies, officials, etc. O4. Coordinated, effective system produces most benefit O5. Potential to improve access to care and meds for all Likely Impact P+I / 2 2 3 3 3 5 5 5 5 3.5 4 4 4
3
5
4
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Access to Care and Meds SWOT Analysis: Key Objective - Threats
Threats (external) T1. Further cuts in grant budget T2. Lack of buy in from the community T3. Factors required for an effective medical home not met (i.e. transportation, health literacy, policies, etc) T4. Suboptimal patient/provider relationship Likely Impact P+I / 2 1 2 3 2 5 5 1.5 3.5 4
3
4
3.5
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SWOT: Probability of Success
S & W = X = 0.9 O & T = Y = 0.5
Objective likely to succeed
Opportunity
O2-5 O1
W3 W2 W1
S4 T1
S1
S2-3
Weakness
Strength
T2 T4 T3
Threat
88
Notes
89
90
Appendices
91
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Breakout Work Sheet Session I January 28, 2005 Access to Care and Medication
Access to care and medications (assess barriers, create models and methods for addressing or removing barriers, identify resources for transportation and medication assistant programs, create resource manual for quad-county, and create sustainable programs). II. Group Members: Access to Care and Medication(s) 1. Priscilla Brantley Facilitator 2. Casey Fitts, MD 3. Steve Squadron 4. Ronald Ravenell 5. Reba Hough Martin Resource Person Assignment: 1. Select a group leader and a recorder. (Group leader will facilitate discussion and report results) 2. Seek to determine the following: a. Identify top 3 compliance needs regarding access to care and medication (focus: what are African American's not doing that adversely affect their health care outcome) b. Determine barriers to African American's compliance (include how to determine cost of implementing recommendations) c. Determine ways to overcome barriers. d. Determine ways to sustain alternative program 3. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a. Which agency or group will be lead for implementation, b. What person will lead this program initiative, and c. List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: ___________________________________Phone: ________________________ Barriers: ______________________________________________________________________ Intervention Current Resources New Needed Resources 1. 2. 3.
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Report Sheet (Pass in to Coordinator)
1. Select Group Leader and recorder: 2. Seek to determine the following: Priscilla Brantley Reba Hough-Martin Group Leader Recorder
A. Top 3 compliance needs regarding access to care and medication (focus - what are African American's not doing that adversely affect their health care outcome) 1. Lack of regular care 2. Not taking medications regular 3. Life styles (exercise, diet) B. Determine barriers to addressing top three needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1. Affordability Comm health ctrs, free Improve coord and org clinics, prescription drug program 2. Lack of education Pt + provider- providers Cultural compentency, cultural competencies tap increase use of samples into existing resources increase sensitivity to cultural needs 3. Transportation Medicaid transp, RTMA More efficient system, alternative transp systems 4. Not having medical home Provide com hlt ctrs, free Develop clearing house to clinics improve coord resources 5. Pt buying into process Family / com 6. Lack of support system Family / com C. Determine ways to overcome barriers Determine barriers Identify current resources 1. Affordability Prescription drug prog, comm. hlt. Ctrl, medication assist prog 2. Transporation Com + church vans- -car pool 3. Education Schools, family, comm., providers Identify needed resources Coord access to info, educate in utilizing drug resources Coord alternate services utilizing volunteers, Health educators, repeat instructions, make sure pt. understand education tools - encourage to ask questions improve quality and efficiency of hlt ministries- dev speakers bureau, be persistent, incorporate exercise prog
4. Medical home
Providers, nurses, health education 94
5. Pt buying in/fatalism 6. Support system 7.
Simplify instructions Family , comm., churches
D. Determine ways to sustain alternative program Determine barriers Identify current resources 1. Encourage community and church resources 2. 3.
Identify needed resources
Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: A. Education on hypertension and stroke Increase awareness, medical professional, patients + communities, assessment of services available + increase coord of these services B. Early detection and referral for hypertension and stroke Early detection Prevention C. Promote healthy lifestyle ________________________________________________________________________________________ ________________________________________________________________________________________ __________ D. Enhance B/P control to 70% of treated patients ________________________________________________________________________________________ ________________________________________________________________________________________ __________ Determine: a). Which agency or group will be lead for implementation, b). What person will lead this program initiative, and c). List barriers you see to moving forward. Agency: _______________________________________________________________________ Leaders Name: ___________________________________Phone: ________________________ Barriers: ______________________________________________________________________________ Intervention Current Resources New Needed Resources 1. 2. 3. Eval: surveys Be able to id target group Baseline thru surveys Able to quantify (# ER visits) Increase focus on schools having to do community services Incorp outreach into schools 95
Access to Care and Medications
Session II June 17, 2005
Access to care and medications (assess barriers, create models and methods for addressing or removing barriers, identify resources for transportation and medication assistant programs, create resource manual for quad-county, and create sustainable programs). I. Group Members: Access to Care and Medication(s) Priscilla Brantley Group Leader Casey Fitts, MD Steve Squadron Ronald Ravenell Reba Hough Martin Pam Mazyck Gardenia Young Rosa Snipes Jimetta Martin Daniel Hoskins Recorder Sheryl Mack Resource Liaison Assignment: 1. Seek to determine the following: a. Identify top 3 compliance needs regarding access to care and medication (focus: what are African American's not doing that adversely affect their health care outcome) b. Determine barriers to African American's compliance (include how to determine cost of implementation) c. Determine ways to overcome barriers identified in "b". d. Determine ways to sustain alternative program 2. Identify how each of the four core objectives will be affected by this intervention(s). Core Objectives: a. Education on hypertension and stroke b. Early detection and referral for hypertension and stroke c. Promote healthy lifestyle d. Enhance B/P control to 70% of treated patients Determine: a.) Which agency or group will be lead for implementation, b.) What person will lead this program initiative, and c.) List barriers you see to moving forward.
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Report Sheet (Pass in to Coordinator)
Group Leader and Recorder: Priscilla Brantley - Group Leader Daniel Hoskins - Recorder
Seek to determine the following: Top 3 compliance needs regarding access to care and medication (focus - what are African Americans not doing that adversely affect their health care outcome) 1. Lack of regular care (preventive, detection, and routine follow-up) 2. Not taking medications regular (affordability, perception of continuous need) 3. Life styles (exercise, diet, etc.) A. Determine barriers to addressing top three needs (include how to determine cost) Determine barriers Identify current resources Identify needed resources 1. Affordability Comm health ctrs, free clinics, 1. Improve coord and org (to local, county, state and federal reduce replication of services administration, prescription drug and use of resources. program 2. Increase clearer communication and trust. 2. Lack of education, patient, Providers (all) continuing Cultural competency, increase public, and health care providers medical education tap into use of samples health fairs, (all) existing agency resources ie, speakers bureau, encourage culture competency models q...