Jefferson County’s Public Health Department has produced its quadrennial strategic plan, informed by significantly more public input than before and focused more tightly on improving mental health and on health care access and quality.
“My goal was to keep this simple,” said Pam Hanna, the county’s public health supervisor. “We looked at fewer priorities, and not so many activities. If we were really going to make progress, we needed to make things simpler.”
The so-called Community Health Improvement Plan (CHIP) was anchored in data from the county’s Community Health Assessment, published earlier this year, including interviews, focus groups, and 228 survey responses — more than twice the number collected four years ago — as well as state and national metrics.
That data led the county to similar strategic priorities as in its 2020 plan — but with some important distinctions.
For example, the plan’s first priority area, mental and behavioral health, is tethered to two core objectives. The first, lowering the percentage of young people who report feeling sad or hopeless for two weeks in a row, is essentially the same as four years ago, but with a new goal. The 2020 plan, targeted a reduction in the percentage to 36% from 41.5%; the new plan aims for a decline to 33.2%, from 38.2%.
But the county’s second mental health objective focuses squarely on reducing the suicide rate, which was 38.9 per 100,000 population from 2018 to 2022, to 27.3 by the end of 2027. The county’s suicide rate is significantly higher than state and national averages, though it’s based on a small data set.
The Public Health Department, working with a wide range of community-based partners, expects to combat suicides by expanding the number of support groups for people living with mental health or substance use disorders. It’s also working to create a crisis response system that would provide more effective care with less reliance on emergency services and law enforcement.
By contrast, the 2020 plan focused on lowering the percentage of people who perceived access to mental health services to be a problem; and on reducing the number of drug use hospitalizations. Hanna said the shift away from drug use was driven by the desire to rationalize activities, and also by a change in public input; in this year’s survey, she said, “drug use wasn’t something that popped up” as frequently.
The county’s second priority area targets healthcare access and quality — again, a narrower description than the 2020 plan, which sought to “preserve, protect [and] restore” physical health.
Where that 2020 plan focused on improving access to places for safe physical activity, the new CHIP targets preventative screenings, seen as a key way to improve long-term health outcomes. The county aims to increase the rate of cervical cancer screenings to 85.8% from 83.2%, mammographies to 75.8% from 71.4%, colorectal screenings to 74.4% from 71.4%, and cholesterol screenings to 87.3% from 84.7%. The county’s current rates for these services are comparable to U.S. rates except for mammographies, which are lower.
Hanna said that the new targets were set on the advice of epidemiologists and by examining state and national comparisons to understand how much change the county could expect to see from certain activities within a three-year window. “We tried to make [the goals] realistic and attainable,” she said.
The county is sustaining its focus on emergency care — by conducting an assessment of the current EMS system; putting in place national and state-recognized quality measures to benchmark patient outcomes; and creating written contracts, anchored in performance measures, for each EMS agency in the county.
But in contrast with the 2020 plan, which focused primarily on reducing response times of emergency care providers, the new CHIP targets quality metrics. It aims to improve the rate of pain assessments for injured patients, to 85% from 78%; reduce pain; document a complete set of vital signs for 90% of patients, from 73%; and double the rate of activation of trauma alerts to receiving hospitals for relevant patients, to 40% from 20%.
Hanna said residents are still concerned about emergency response time, which in Jefferson County lags many communities. But the shift in metrics came from the recognition that, in a rural context, “we really can’t control the time in a lot of cases. But we can control the quality we give once we respond.”
The 2024 CHIP was stewarded by a core planning group that included Hanna, County Health Officer Jim Murphy, Boulder City Council President Drew Dawson, Boulder Community Library Director Jodi Smiley, County Planning Director LaDana Hintz and Planner Lindsey Graham, and Prevention Specialist Barb Reiter. They were joined by 18 community stakeholders, many of whom have taken on leadership of the plan’s various strategic activities.
Hanna hopes that the result is concrete and specific enough to inspire effective action, and accessible enough to invite broad participation from individuals and entities within and beyond the county. “Hopefully, this plan will engage other actors as we go along,” she said. “This is everybody’s work.”
