Transforming Communities Initiative (TCI)...8 communities are part of TCI using policy, system and environmental change strategies to reduce tobacco use and obesity, and address social

Jaime Dircksen, AMVice President, Community Health & Well-BeingTrinity Health

Transforming Communities Initiative (TCI)

People-Centered Health System

Trinity Health Operating Platform

Episodic Health Care Management for Individuals

Today, our strategic plan is focused on being a people-centered health system that delivers the Triple Aim for individuals, populations and communities

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Population Health Management

Community Health & Well-Being

CHWB is optimizing wellness and equity, and eliminating disparities in our communities by…

Addressing Individuals’

Social NeedsImproving

Community Conditions

Leveraging resources and partnerships


8 communities are part of TCI using policy, system and environmental change strategies to reduce tobacco use and obesity, and address social influencers of health


National Partners

TCI is a 5 year initiative deploying an innovative funding model


GRANTS: $18M for communities + $7M in community match

LOANS: $40M in community loan investing

Tobacco-free Living

School Wellness Food Access Childcare

Centers Complete Streets Breastfeeding

Housing Early Childhood Economic Development

Other Interventions

- Trinity Health Hospital- Community Based Organization (s)- Local evaluator- Local government public health- Local school district (s)- Community resident(s)

TCI communities have key partners working together to accelerate progress


• Committed partnership between Trinity Health Hospital and Lead Community Based Organization

• Full-time program director• Local Evaluator (funded 15% of award, minimum)• 50% of funds must be directed to community partners• Access to Trinity Health Investment Loans • Access to national technical assistance partners to support

- Community engagement- Policy- Communications- Tobacco Control Policies- National Evaluation

Each TCI community has dedicated resources


Templates• TCI award manual• TCI community action plan

(modeled after CPPW)• Monthly performance

monitoring tool• TCI annual report• TCI annual evaluation report

On-Going Support• Monthly Program Director

Call• Monthly 1:1 with Program

Director & Trinity Health• Monthly all Evaluator call• Annual Learning Institute

TCI provides guidance and templates for all communities to document their plan and share successes


• Center the people (demographic and interest groups) and places (geographic locations) that bear the brunt of the impact of existing inequities in PSE outreach, planning, implementation and evaluation

• Develop outreach solutions and strategies that are culturally, linguistically, and physically appropriate

• Develop partnerships and leadership teams that include a mix of technical advisors and people impacted by the problems we seek to impact

• Establish coalition practices that build trust and transparency with community partners and residents--See PolicyLink, Get Ready: Build the Base for Equity Advocacy.

Achieving sustainable, long-term transformation in TCI communities requires the input, partnership, and leadership of the people we seek to serve


http://www.policylink.org/sites/default/files/GEAR_Snapshot_buildthebase_magcloud_0.pdf

• Each community must budget a minimum of 10% annually for public education/mass media campaigns to support the PSE strategies

• Funds/personnel should support strategic and integrated media and communications activities to help advance TCI efforts to key audiences (public, partners, stakeholders)

• All TCI communities are participating in the cross-site coordinated communication effort “campaign” to promote equitable healthy school environments that enable all students to learn and grow

System change is not possible without on-going communications strategy


• RE-AIM framework standardizes the reporting of high-level components across sites –(R)each, (E)ffectiveness, (A)doption, (I)mplementation, and (M)aintenance of PSE strategies – while allowing for variation in local data, strategies, and timelines

• Over the five‐year initiative, evaluation will address the following:1. What PSE strategies are planned, adopted, and implemented?2. How are TCI resources utilized and leveraged?3. What are the coalition and community factors that influence progress and success?4. What is the population reach of the PSE strategies, and what is the predicted or

measured impact on behavior or health?

• The cross-site evaluation uses three data collection strategies: 1) key informant interviews, 2) a coalition partner survey using an online anonymous version of the Wilder Collaboration Factors Inventory, and 3) document review of community action plans, annual site reports, local evaluation plans, TA reports, and monthly performance monitoring reports.

Evaluation informs decision‐making to modify and scale-up other communities



TCI Highlights

25 Trinity Health communities have passed Tobacco 21 policy at state and/or local levels

National Partners

Through TCI efforts, 7.7M youth* reached through passage of T21 in 6 States*California passed T21 legislation in June 2016, pre-dating TCI and is excluded from this reach

Work on T21 policy has impacted nearly 14 million individuals, ages 15 -24 nationwide

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Annual Cumulative

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Tobacco-free Living

13


TCI efforts are working with multi-sector collaborations to reduce youth obesity

393 Schools & estimated 261K students impacted by school wellness activities

Over 200K lbs of healthy foods produced/recovered & nearly 2K screenedfor food insecurity

Helping communities make the healthy choice, the easy choice

Food AccessSchool Wellness

School Wellness

PP4H utilized funding to create Active Recess across all local elementary schools by turning empty blacktop spaces into an active playground through stencils that children and adults can use to play when outside during recess

Increasing physical activity with access to safe places to play


Food Access


TCI is making healthy foods accessible In Syracuse, the team is working intensively with 8 corner stores to increase access to healthy food options

- Corner stores are within 1000 feet of a school and serving 6,100 people within ¼ mile

In Year 1, stores received funding to make environmental changes including

- purchasing refrigeration units, produce baskets and healthy food promotion signs

During Year 2, most stores are selling 4-6 types of fruits and veggies- Stores are creating more healthy ads than unhealthy ads - Stores are creating checkout areas with more healthy than

unhealthy products

School Wellness

• Developing a cross-site media campaign to create a healthier school environment through improved School Wellness policy and/or implementation, to improve student learning and overall health. Campaign includes:- Policy analysis and support

• Federal advocacy from Trinity Health System Office• Local/state monitoring (Changelab Solutions)• School Wellness Policy Assessment, using the WellSAT tool (ChangeLab Solutions)

- Learning community for school wellness leads and partners (Community Catalyst)• Shared learning• Support each other through implementation

- Coordinated communications support (PGP)• Creative and messaging development• social media influencers• Paid advertisements

TCI’s school wellness strategy is focused on nutrition and physical activity in schools


School Wellness

• Videos have been created for topics including - physical activity in the classroom- healthy fundraising- chronic absenteeism- Safe Routes to School- school food nutrition- mental health

TCI’s cross-site communications campaign will use social media influencers to reach parents


School Wellness• Promise Partnerships collaborated with a variety of

stakeholders to develop and implement the first community schools in Idaho - Services include - food assistance- English second language classes for adults- childcare- connections to housing assistance- medical and dental care- job assistance- academic support for students

Community Schools brings essential services to neighborhoods by removing barriers of access


Food Access


Urban gardens are essential for access to healthy foodsIn Maywood, Trenton, Springfield and Syracuse teams are working with schools and community gardens to provide access to healthy foods

Childcare Centers


Connecting with parents helps children create healthy habits early• Trenton started a two-year, mini-grant initiative to

support new playground equipment and play materials that encourages greater physical activity

• The coalition has strengthen their community engagement with the Trenton Public Schools Office of Early Childhood, early childhood center leadership, staff, parents and students

• Trenton also provided funding for state-of-the-art, stadium-quality LED lighting installed at a local community field, which resulted in expanded soccer activities for children living in public housing

Complete Streets


Complete Streets help to make safe passages • Promise Partnerships completed a Complete Streets evaluation

in the City of Caldwell and all street design guidelines and comprehensive plan changes were adopted by the City in fall 2018

• The Bike & Pedestrian plan is expected to be adopted in 2019 The first subdivision was approved under the new guidelines; will be the first subdivision in two generations to have detached buffered landscape sidewalks

• Caldwell was able to leverage the data collected through the TCI work to obtain a Safe Routes to School grant for $250,000 to construct the first bike lane with curb, gutter, along a 1 mile stretch in front of a community school

Breastfeeding• In Idaho - legislature passed a bill to protect breastfeeding mothers

from indecent exposure and obscenity laws; Idaho is the final state in the U.S. to protect women breastfeeding publicly

• In Syracuse - the coalition has built and/or outfitted 20 lactation rooms throughout the City of Syracuse to provide safe, private areas for mothers to breastfeed

• In New Jersey - Legislation (A2294) was passed defining breastfeeding as a civil right, and was signed into law by then-Governor Christie in January 2018; the bill requires that employers make reasonable accommodations within workplace settings for mothers to express milk - ancillary pieces of legislation also exempted breast pumps and equipment from sales tax and set standards for breast milk banks

Providing mothers the opportunity to safely breastfeed


Loan Recipient: Patriot Village Urban Renewal Associates II, LP, an affordable housing development in Trenton, NJ.Supported Market: Trenton, NJ (RHM: St. Francis Medical Center)Terms: $1.0M at 2.0% for 20 years.Total Project Financing: $19.9M (Nearly 20-1 leverage of Trinity Health’s support) Targeted Programming: Finance the construction of a 72-unit affordable housing development that is targeted to serve families and individuals making 60% of area median income (~$59K/year for a family of four). All residents will have access to a range of services such as financial management, health and wellness activities, and educational activities for children. Social Determinant of Health: Housing and Built EnvironmentTargeted Patient Outcomes: Improvements in ambulatory care sensitive conditions (specifically readmissions).

Loan Spotlight: $1.0M to develop affordable housing in Trenton, NJ (Patriot Village II)


• $1.5 million loan commitment to the Healthy Hartford Hub, which is a proposed $32 M project to build a supermarket, a health-related venture and mixed 25-unit housing and to improve public park space in the North Hartford Promise Zone (NHPZ).

• Trinity Health loan commitment for $1.5 million at 2% for 10 years will reduce overall borrowing cost and improve likelihood of philanthropic awards to project.

• Hartford ranked 8th worst in the nation among comparable size cities for providing low-income residents access to healthy foods.

- 42% of city residents lack access to a vehicle – a trip to the closest grocer for a NHPZ resident can take over 1 hour on a CT Transit bus.

Expanding access to healthy food in Hartford, CT


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TCI Key Learnings to Date

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• Being a flexible funder is key to partnership and success• Resident and community partner engagement is essential

to successfully implementing strategies that the community is ready to tackle (not the funder)

• Take time to develop the initial plan (6 months-year)

TCI begins Year 4 on July 1, and we have learned from our communities


Questions?


• Contact: - Jaime Dircksen, VP, Community Health & Well-Being

[email protected]

- Beth Geno, Manager, Grants & Community Initiatives [email protected]

29©Trinity Health 2019, All Rights Reserved

When you need us:

mailto:[email protected]

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Transforming Communities Initiative (TCI)...8 communities are part of TCI using policy, system and environmental change strategies to reduce tobacco use and obesity, and address social

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