March 2005

Grant Results

SUMMARY

The Ingham County Health Department, working in partnership with hospitals, employers, consumers and insurers in Lansing, Mich., created an organized system of care for county residents.

This included health plan coverage for the uninsured and a network of neighborhood-based services in distressed inner-city communities.

Between 1994 and 2004, the Robert Wood Johnson Foundation (RWJF) awarded two grants totaling $498,521 to support this project (ID#s 023969 and 031797).

The first grant laid the basis for the communities' organized system of care. Under the second grant, the Ingham County Health Department and its partners led multiple stakeholders (consumers, employers, hospitals and insurers) in a community mobilization process.

Key Results

  • The project team conducted two large community forums and associated smaller group sessions to foster community participation.
  • The Capital Area Health Alliance produced the Action Plan for an Organized System of Care for the Capital Area.
  • Health care coverage of the uninsured in Ingham County increased, with over half the county's uninsured population in 2000 enrolled in the Ingham Health Plan by 2002.
  • Four neighborhood centers became hubs for collaborative service delivery and community mobilization.

Funding
RWJF provided partial funding for this project with two grants totaling $498,521 between November 1994 and January 2004. In 2003, the W.K. Kellogg Foundation awarded Ingham County a four-year grant of $910,000 to continue the community mobilization process.

 See Grant Detail & Contact Information
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THE PROBLEM

In the early 1990s, about 34,000 residents of Ingham County, Michigan (approximately 12 percent of the population) lacked health insurance. Of these, 39 percent said they had been unable to see a doctor in the past year because of cost.

Many of the uninsured lived in distressed inner-city neighborhoods of Lansing (Ingham County's largest city) where high rates of crime, poverty, child abuse and neglect created additional barriers to health care. The uninsured and indigent relied on an uncoordinated set of safety net providers that included the public health department, hospital emergency rooms and nonprofit community health centers.

However, the ability of the three Lansing hospitals (Edward W. Sparrow Hospital, Ingham County Medical Center and St. Lawrence Hospital) to continue providing safety net services was being threatened by cost containment pressures coming from health insurers and major area employers, including General Motors and Michigan State University.

In 1991, a community police officer, Donald Christy, conceived and established Lansing's first neighborhood "network center" (the Eastside Network Center) at a donated site in a high-crime neighborhood where agencies began to coordinate the delivery of health, social, substance abuse, and safety services to local residents.

In a separate event that year, the heads of the major public human service systems in the county formally committed themselves to explore collaborative approaches to the coordination of services for multineed families. Since Officer Christy's network center appeared to present a promising strategy for mobilizing the larger community and promoting interagency cooperation, the Ingham County Health Department became interested in replicating it in other high-need Lansing neighborhoods.

However, to improve health care access throughout the county, the health department recognized that a multilevel response by health care systems, service providing agencies and individuals was essential.

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RWJF STRATEGY

At the time RWJF issued these grants, one of its goals was to improve access to health care among the uninsured. This project aimed to provide an example of how major health care providers, both public and private systems, can work together cooperatively within a highly competitive market to ensure health care for the uninsured.

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THE PROJECT

In 1994, RWJF funded a planning project (ID# 023969) designed to secure citywide commitment to the concept of neighborhood-based services and to expand a fledgling network center system. With the Capital Area United Way acting as fiduciary agent, a project team that included the Lansing Police Department and the Ingham County Health Department led the planning project. They:

  • Created a "Letter of Agreement Regarding Network Center Development in Ingham County," signed by 16 Ingham County executives including the Mayor of Lansing, the chairperson of the Ingham County Board of Commissioners and the heads of each of the county's public human services systems. The executives affirmed a new commitment to neighborhood-based services through the network centers and subsequently formed the citywide Network Center Advisory Board, a coalition of provider agencies and residents, to spearhead ongoing collaborative activities.
  • Selected sites for three new neighborhood network centers and secured state, federal and local financial and in-kind support to launch two of the centers (Northside and Southside centers), and to establish neighborhood advisory groups for them.
  • Created a comprehensive Safe Families/Safe Children Five-Year Community Plan (see the Bibliography). This initial plan, approved by community representatives in March 1995, synthesized 19 previous needs assessments and committed approximately $1,000,000 in available state and federal funds to the delivery of interagency services in the three distressed Lansing neighborhoods where the new network centers were to be located.
  • Engaged the three Lansing hospitals (Sparrow Hospital, Ingham County Medical Center and St. Lawrence Hospital) and the Ingham County Health Department in discussions about a practical, collaborative approach to covering the uninsured. These discussions formed the basis for a proposal to implement the initial community plan, submitted to RWJF in March 1997.
  • Secured a design for an evaluation of the network centers, created by staff at Michigan State University.

In 1997 RWJF awarded the Ingham County Health Department a second grant (ID# 031797) to help implement this project (now called "Access to Health"). Its purpose was to support the community's major health providers in expanding access to care for the uninsured while also working to integrate existing health and social services. To achieve this goal, the Ingham County Health Department and its partners: (1) expanded coordinated health and social service delivery at the three selected neighborhood network centers; and (2) pursued health coverage for the uninsured through a collaboration between the two remaining Lansing hospitals, Sparrow and Ingham County Medical Center (St. Lawrence Hospital merged with Sparrow in 1997).

Soon after RWJF's second grant, two events occurred that expanded the scope of the project and made the attainment of an organized system of care more feasible.

  • In July 1998, Ingham County Health Department was one of 13 sites in the country to receive a five-year $2.5 million grant through the W.K. Kellogg Foundation national program, Community Voices: Health Care for the Underserved. The Community Voices grant augmented the RWJF-funded project by supporting large community meetings, or health care "summits," and leadership training in the neighborhoods where the network centers were located. It also strengthened project outreach to minority communities, allowed an increased focus on the uninsured's access to oral health care, and freed RWJF funding to address mental health care and treatment for substance abuse in the community.
  • In October 1998, the Ingham County Health Department launched the Ingham Health Plan, a new coverage plan for the uninsured that provides members with a card, a medical "home," access to primary and specialty care, and prescriptions and diagnostic services for a small co-payment. Ingham County funded and managed the plan through the nonprofit Ingham Health Plan Corporation, which combined county and state dollars earmarked for low-income and uninsured people and allowed use of them to draw down federal Medicaid matching funds in the form of a special "disproportionate share" hospital payment.

The Ingham County Health Department subsequently used RWJF and Kellogg funds to lead a broad community mobilization and engagement process, called the community dialogue process, that forged what the project director describes as the "community will" to cover the uninsured. The process included community forums and health care summits as well as smaller learning sessions, workshops and focus groups. Dialogues engaged multiple stakeholders (consumers of health care, insurers, health care systems and providers) in discussions of health care needs and access problems (including barriers to enrollment in the Ingham Health Plan).

The dialogue process produced action plans for an organized system of care for the county as a whole, as well as for specific neighborhoods. It also addressed broad access goals as well as specific problems, such as substance abuse. In 2001, Ingham County received a three-year grant of $1,408,185 from the federal Health Resources and Services Administration's Community Access Program, which allowed the county to expand both the dialogue process and Ingham Health Plan coverage to adjacent Clinton and Eaton counties. These, together with Ingham County, form the Capital Area Community.

Two Lansing organizations played key roles in the Access to Health project. The Capital Area Health Alliance, an existing communitywide forum for consumers, employers, hospitals and insurers, assumed responsibility for sponsorship and oversight of the community dialogues and action plan. The Network Center Advisory Board, a coalition of provider agencies and residents (noted above), provided continuing direction and oversight for the network centers and leveraged funding to sustain them. At three of the network centers local boards provided additional operational oversight.

The W.K. Kellogg Foundation and the federal Health Services Resources Administration's Community Access Program provided major financial support for the project. See Appendix 1 for details on this funding, as well as a list of other project supporters.

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RESULTS

The project staff reported the following accomplishments:

  • In 1999, the project team conducted two large community forums, and associated smaller group sessions, to foster community participation in planning and promote buy-in to the project. The first forum, held in February 1999, resulted in agreement on five principles for an organized system of care in Ingham County, which was based on the text of extensive interviews with community residents and stakeholders. (See Appendix 2 for a list of these principles.) The second forum, in November 1999, resulted in an initial set of action steps to achieve this system of care. Participants based these action steps on recommendations from "learning sessions" that followed the February 1999 forum. The recommendations were focused on who the uninsured are, what services are available to them, and how these services are funded. See the Bibliography for further details about these two community forums.
  • In 2001, the Capital Area Health Alliance produced the Action Plan for an Organized System of Care for the Capital Area, based on an additional two years of community dialogue. The alliance became the sponsor of the project's ongoing dialogue process in 1999. The Action Plan incorporated ideas from approximately 300 Lansing-area stakeholders, including insured and uninsured consumers, large and small employers, providers, insurers, and organizations representing the African-American, Latino/Chicano and Native American communities. It defined five components of an organized system of care:
    • A coordinated set of coverage options (insurance or other defined benefit).
    • A coordinated health care delivery network.
    • A community-wide capacity to link people to coverage.
    • Sustainable funding.
    • Administrative oversight.

    The plan also outlined seven broad goals for ensuring 100 percent access to health care and assigned responsibility for implementing action steps in each goal area to local lead entities. These entities included the Ingham Health Plan Corporation, the Ingham County Health Department, the two Lansing hospitals (Sparrow and Ingham County Medical Center), and other community organizations and residents. In late 2001, residents and members of the Capital Area Health Alliance further refined the plan by identifying indicators of progress toward its goals. The Community Briefing 2002 report summarized progress toward the goals. (See the Bibliography for publication details of the Briefing and Action Plan; see Appendix 2 for a list of the plan's goals and the indicators of progress for each goal.)
  • Health care coverage of the uninsured in Ingham County increased, with over half of the county's uninsured population in 2000 enrolled in the Ingham Health Plan by 2002. Several documents (Community Briefings 2002 and 2004, Ingham County Health Department Access to Health Project Evaluation, and reports to RWJF) document the improvement in access to health care for the uninsured and indigent in Ingham County:
    • By August 2002, the Ingham Health Plan had enrolled 15,821 members, approximately 57 percent of the uninsured population of Ingham County in 2000. According to the project director, the community dialogue process made possible by the RWJF and W.K. Kellogg grants was an important means of expanding awareness of the plan's existence and eventually increasing enrollment. (Community Briefing 2002; February 2004 report to RWJF)
    • Over the course of the project, a total of 28,880 different people received health care services as members of the Ingham Health Plan. (Report to RWJF)
    • As of August 2002 more than 100 providers participated in the Ingham Health Plan. (Access to Health Project Evaluation)
    • Health care coverage for adults in Ingham County improved, with 91 percent of adults in Ingham County indicating they had coverage in 2003 compared to 89 percent in 2000 and 87 percent in 1997. (Community Briefing 2004)
    • The Ingham Health Plan Prescription Program, a discount program created in October 2000 that is open to both plan members and non-members throughout Michigan who do not have other prescription coverage, in 2004 was saving participants approximately $250,000 per month in prescription drug costs. (Report to RWJF)
    • In a 2002 survey of Ingham Health Plan members, 97 percent of those who responded indicated it was very easy or somewhat easy to enroll in the plan. On an ascending scale of 1 (poor) to 10 (excellent) members rated their overall experiences with the plan at 7.8. In a separate survey of clinics in the Ingham Health Plan network, also conducted in 2002, 64 percent of staff indicated that it was very easy or somewhat easy to enroll patients in the health plan. (Community Briefing 2002)
  • Four neighborhood centers became hubs for collaborative service delivery and community mobilization, which resulted in community residents making greater use of the organized system of care. The four centers are the Northside Network Center, the Allen Neighborhood Center, Wexford Neighborhood Network Center and Baker-Donora Focus Center. A fifth center (the Southside Neighborhood Network Center) did not establish a strong network of local support and its impact on the community was limited. The Access to Health Project Evaluation, The Power of We — Strengthening Community Connections for Action, and reports to RWJF document the four hub network centers' impact on their communities:
    1. Beginning in 1999, centers used a combined annual allotment of $70,000 in RWJF funds to leverage new resources to sustain their activities. Between 2000 and 2003, the number of partner organizations for the network centers grew from 108 to 190 and total funding increased from $664,000 to $1,059,000. This support, according to the project director, reflected the centers' ability to connect and deliver programming in new and creative ways to the neighborhoods they serve. (Report to RWJF)
    2. The network centers identified 35 community outreach workers who received training and, beginning in 2000, financial support from the Ingham Health Plan Corporation (Access to Health Project Evaluation)
    3. The outreach workers enrolled 2,364 people in the Ingham Health Plan and connected them to services of the county health department, such as a dental clinic and breast and cervical screening programs (Access to Health Project Evaluation)
    4. Each of the centers initiated service programs tailored to the needs of its neighborhood residents. The centers offered services that included: housing assistance through an affordable housing task force; a bookmobile and adult education classes in partnership with the Lansing School District; foster parent recruitment, education and support; meals and social programs for the isolated elderly (known as "Seniors Dining in Style"); free legal assistance; and a neighborhood-based parent aide program. (The Power of We)
  • 2001 and 2002 community dialogues on substance abuse and mental health addressed the need for improved access to treatment. The Capital Area Health Alliance added these dialogues to the original Action Plan goals at the request of community stakeholders. Two state agencies (the Mid-South Substance Abuse Commission and Clinton-Eaton-Ingham Community Mental Health) acted as lead entities for the dialogues. In 2001–2002, 18 community forums on substance abuse engaged 285 stakeholders in a nine-county area. The sessions and associated focus groups and surveys resulted in a report, From Dialogue to Action: Recommendations for Increasing Access to Substance Abuse Prevention and Treatment Services. (See Appendix 3 for a list of the report's recommendations.) The mental health dialogues, encompassing a three-county area, began in 2002 and as of 2004 are ongoing.

Communications

To disseminate information about the project and gather input from stakeholders, project staff and partners sponsored five community meetings in Lansing between February 1999 and September 2004 (the W.K. Kellogg Foundation's Community Voices initiative funded several meetings and other associated outreach). Attendance at meetings ranged from 150 to 250 participants. Staff distributed project documents at these meetings, including Setting the Community Table: The Stakeholders Speak on Access to Healthcare (February 1999), Action Plan for an Organized System of Care for the Capital Area (February 2002), and Community Briefings (September 2002 and 2004). The Action Plan, the 2002 Community Briefing, the evaluation, and the substance abuse reports are available at the project Web site.

As of 2004, staff had distributed approximately 2,000 copies of a draft Action Plan and 1,000 of its final version to community residents, and to interested parties statewide and nationally. The Capital Area Health Alliance plans to publish biannual Community Briefings to update stakeholders on progress toward the Action Plan goals. In 2001, staff coordinated a year-long media and grassroots enrollment outreach effort throughout the greater Lansing area. In 2003, the project coordinator spoke on the project's community outreach before the U.S. Congressional Black Caucus. In 2004, he made another presentation, "The Ingham Health Plan: Using Community Will to Create Coverage for the Uninsured," at the annual American Public Health Association conference in Washington. In 2004, the project director addressed a Georgia advocacy group (the Campaign for Adolescent Pregnancy Prevention) on the project's success in maximizing community health resources. (See the Bibliography for details on community meetings, publications and presentations.)

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EVALUATION

RWJF, the W.K. Kellogg Foundation and the federal Community Access Program co-funded a three-part evaluation of the project's organized system of care. Public Sector Consultants, a Lansing-based corporation specializing in program evaluation, conducted the evaluation. The RWJF-funded component focused on the effectiveness of community engagement and mobilization efforts at the neighborhood network centers. The evaluators gathered information through personal interviews with the five network center directors, the network center coordinator, and through focus groups conducted at four of the neighborhood centers. Thirty-four people participated in the focus groups, including senior citizens, neighborhood residents and network center volunteers. Public Sector Consultants summarized their findings in Ingham County Health Department Access to Health Project Evaluation. See Lessons Learned for key findings from this report.

Evaluation components funded by the W.K. Kellogg Foundation and the Community Access Program focused on three project objectives:

  1. increased enrollment and delivery of health care
  2. improved understanding and utilization of available health care
  3. improved satisfaction with available health care services by enrollees in the Ingham Health Plan.

The evaluators based their findings on Ingham Health Plan documentation, data compiled for the Community Briefing 2002, and surveys and interviews conducted with current Ingham Health Plan members and clinic staff. Findings from these components of the evaluation appear in the Results section of this report.

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LESSONS LEARNED

Public Sector Consultants and the project director identified the following project lessons:

  1. The proposal planning process can be a powerful community organizing tool. The prospect of grant funding was one incentive that drew the Lansing hospitals to planning meetings in 1996 and 1997. At these meetings, the hospitals and the county health department discussed a wide range of issues, not just those related to the grant application. (Project Director)
  2. The high visibility of the project's public dialogues motivated key partners, who otherwise might have withdrawn, to remain engaged in essential planning and implementation. Although the competitive relationship between the project's two hospitals made it difficult for them to agree on their approach to care for the uninsured, the public's attention to the access-to-health care dialogue prevented them from disengaging from the process even during points of tension. (Project Director)
  3. When residents show their strong support for an organized system of care, they help it by influencing the political behavior of community organizations and leaders. For example, in a recent election, every candidate running for the Ingham County Board of Commissioners identified access to health care as a priority on his or her platform. (Project Director, Evaluator)
  4. Neighborhoods need flexibility in designing governance structures, development activities and processes that will respond to their community's concerns. "One size does not fit all," according to the project director, who noted that the initial network center model was "too arbitrary." Instead of requiring each center to establish an interagency team with representatives from health, social services, education and law enforcement, the project director believes success came from allowing neighborhoods to "do what they do best," define their own needs and develop their own partnerships. (Project Director, Evaluator)
  5. Providing stability in administrative support contributes to the credibility of the neighborhood centers, which in turn increases to their ability to obtain further resources. Center directors appreciated being allowed to use their RWJF funds to cover administrative costs, "things that were not covered in any other way," commented one director. The Allen Neighborhood Center used its $22,000 annual allotment from RWJF to leverage about $260,000 in funding from other sources. (Evaluator, Project Director)
  6. Neighborhood centers provide a place for residents to build individual relationships and trust, elements essential to community teamwork. Directors saw their centers as "neighborhood-friendly points-of-access," leading to improved communication and further development of trusting relationships, critical building blocks for community health improvement. While the centers are a good first step, center directors also noted that more resources and grassroots strategies are needed to reach the people in the community who are hardest to engage. (Evaluator)

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AFTER THE GRANT

As of 2004, the Ingham Health Plan was expanding with a sustainable base of local, state and federal funding. In November 2004, the plan had enrolled about 16,000 members, 60 percent of the uninsured population. The county's "Ingham County Advantage," which offers subsidized health insurance to employees of small businesses in the county, opened in June 2004; five businesses have enrolled. Nineteen health plans similar to the Ingham Health Plan are now operating in Michigan, covering at least 100,000 individuals. The Ingham County Health Department acts as paid manager for 11 of these plans.

Four neighborhood network centers (Baker-Donora Focus Center, Allen Neighborhood Center, Northside Network Center and Wexford Neighborhood Network Center) also continue as of 2004, with a broad base of financial and in-kind support from local, state and national partners. A consortium called "The Power of We," established in 2002 by health, business, education and consumer groups in the Capital Area Community, works to provide sustained support for the neighborhood centers by pooling public, private and foundation dollars.

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GRANT DETAILS & CONTACT INFORMATION

Project

Development of an Organized System of Health Care for the Indigent

Grantee

Capital Area United Way, Inc. (Lansing,  MI)

  • Planning a Communitywide Service Program for Multiproblem Families
    Amount: $ 48,521
    Dates: November 1994 to October 1995
    ID#:  023969

Grantee

County of Ingham Health Department (Lansing,  MI)

  • Development of an Organized System of Health Care for the Indigent
    Amount: $ 450,000
    Dates: January 1998 to January 2004
    ID#:  031797

Contact

Bruce B. Bragg, M.P.H.
(517) 887-4311
braggb@ingham.org

Web Site

http://www.CACVoices.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Additional Support for the Project

The following provided additional support for project implementation (January 1998 through January 2004):

W.K. Kellogg Foundation

    ($2.5 million over five years, plus $118,490 for the period July 2003–January 2004 and $10,500 earmarked for the project's substance abuse dialogue)

The federal Health Resources and Services Administration

    ($1,408,185 over three years through its Community Access Program, with some support earmarked for replication of the plan in other Michigan counties)

Michigan's Mid South Substance Abuse Commission

    ($130,000)

Other supporters, both financial and in-kind, included the following (November 1994 through January 2004):

  • City of Lansing
  • Corporation for National Service (VISTA)
  • Ingham County
  • Ingham County Health Department
  • Lansing's Capital Area Community Services
  • Ingham Regional Medical Center
  • Lansing School District
  • Lansing Police Department
  • Michigan's Family Independence Agency
  • Michigan State University
  • Sparrow Health System
  • State of Michigan's Department of Social Services


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Action Plan for an Organized System of Care in Lansing: Principles, Goals and Indicators for Tracking Progress Toward Goals

Five principles of an Organized System of Care:

  1. Access to health care is a right for all citizens. Upholding this right in our community entails responsibilities that the entire community must bear.
  2. It is in every stakeholder's interest to create a healthier community. An organized system of care is needed to assure access to quality care for all citizens, and to improve the community's overall health and economic strength.
  3. All health care stakeholders in the community must be at the table, sharing perspectives and working together to resolve access problems in the current health care system. The common goal of all stakeholders is to create, maintain and evaluate an improved system that is both efficient and effective in delivering quality health care to all citizens.
  4. A fair and equitable method of distributing the cost of an organized system of care must be determined by all stakeholder groups collaboratively. The process of determining this method should involve an analysis of the best available information on local health care assets, costs, delivery mechanisms and outcomes.
  5. An organized system of care must foster mutual education of all stakeholders. This will require new thinking by providers, insurers, employers and consumers on the ways in which their policies and practices encourage or discourage healthy life choices and effective utilization of health resources.

Seven Goals of an Organized System of Care:

1. Coverage Goal: Create and sustain coverage strategies sufficient to give all residents access to organized systems of care, by building on current successful innovations in Ingham County.

Indicators:

  • Number with health insurance or coverage, per the Ingham County Health Department survey data.
  • Enrollment in the Ingham Health Plan basic program, and other Ingham Health Plan programs, as a percentage of the baseline number of uninsured.

2. Zero Disparity Goal: Eliminate all barriers to quality health care based upon economic cultural, ethnic and racial differences.

Indicators:

  • Health status data on disparities and increasing information for the community, e.g., reports to the community on health status disparities.
  • Number of people in racial and ethnic minority populations reporting difficulty in accessing needed care as a percentage of survey respondents.
  • Enrollees' and staff opinions on ease of enrollment.

3. Ownership Goal: Mobilize Capital Area leaders to create community ownership of the need for universal access to health care.

Indicators:

  • Existence of community advisory boards for community health centers.
  • Current and former uninsured consumers as a percentage of Ingham Health Plan corporate board membership.

4. Oversight Goal: Engage the community in an ongoing process of analyzing health data and allocating health care resources in ways that will improve health status and health care access for uninsured people.

Indicators:

  • No indicators were tracked for this goal in the Community Briefing 2002.

5. Outreach Goal: Enable both traditional and nontraditional providers of health information to connect people to a full range of services and health education resources.

Indicators:

  • Existence of a communitywide information and referral mechanism.
  • Number of community organizations, service providers and residents who have been provided training on the communitywide information and referral mechanism for health and human services.
  • Number of providers participating in coverage programs.

6. Oral Health Goal: Increase access to oral health services for residents of the Capital Area.

Indicators:

  • Number of people reporting difficulty in accessing needed care.
  • Number of dentists providing care to the Medicaid, uninsured and underserved population.

7. Mental Health and Substance Abuse Goal: Increase access to mental health and substance abuse services for residents of the Capital Area.

Indicators:

  • Documentation of facilitated dialogue to increase public awareness of the need for improved access to mental health and substance abuse services.
  • Number of people served in substance abuse treatment programs.
  • Inability to access services.


Appendix 3

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Project Recommendations for Increasing Access to Substance Abuse Prevention and Treatment Services

The Mid-South Substance Abuse Commission sponsored 18 community dialogues in a nine-county region of Michigan from December 2001 to May 2002. These recommendations (in six goal areas) emerged from the dialogue process:

Concerning Goal 1: Increase Community Awareness and Leadership.

  • Take a holistic approach to community education.
  • Deepen distinct areas of community understanding.
  • Mobilize community leadership among both citizens and service providers.
  • Forge a consensus that substance abuse is a priority issue for us all.

Concerning Goal 2: Reduce Barriers to Accessing Services.

  • Market services and resources available to support treatment and recovery.
  • Streamline access to services and make the process user-friendly.
  • Improve cultural competency throughout the substance abuse prevention and treatment system.
  • Provide more opportunities for referral and service delivery in community settings.
  • Tackle the transportation barrier.

Concerning Goal 3: Improve Substance Abuse Prevention and Treatment Services.

  • Intensify community outreach and screening efforts.
  • Improve the quality and effectiveness of substance abuse prevention and treatment services.
  • Expand the availability of services.
  • Strengthen oversight and accountability for results.

Concerning Goal 4: Establish a Full Continuum of Services Through Communication, Coordination and Collaboration.

  • Bring all stakeholders affected by substance abuse prevention and treatment together to reach consensus on what is missing.
  • Increase the knowledge that each agency has about the services available through other service providers.
  • Increase knowledge and skills across all systems.
  • Create greater collaboration between the criminal justice system and substance abuse service providers.
  • Extend communication and collaboration beyond service providers to include all stakeholders in the community.

Concerning Goal 5: Improve Public Policy.

  • Chart a collaborative course of action.
  • Advocate for clear, sound public policies on substance abuse at the local, state and federal level.
  • Change policy to maximize participation in treatment.

Concerning Goal 6: Increase Resources and Funding.

  • Increase funding for prevention and treatment services.
  • Strike a better balance between funding for prevention and treatment.
  • Re-engineer current funding to maximize resources.
  • Identify and mobilize all community resources that can address substance abuse.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Bloss D. "The Ingham Health Plan: Using Community Will to Create Coverage for the Uninsured." Abstract of presentation at the 2004 Annual Meeting of the American Public Health Association, November 8, 2004. Abstract #84889 available online.

Bloss D and Miel-Uken S. "Harmonizing Diverse Voices in a Community Dialogue on Access to Health Care." Unpublished.

Reports

Safe Families/Safe Children Five-Year Community Plan (October 1, 1994–September 31, 1999). Lansing, Mich.: Ingham County Family Coordinating Council, March 21, 1995.

Doak B. Setting the Community Table: The Stakeholders Speak on Access to Healthcare. Lansing, Mich.: Ingham County Health Department, February 19, 1999. 500 copies produced.

Action Plan for an Organized System of Care in the Capital Area. Lansing, Mich.: Capital Area Health Alliance, February 2001.

Lansing Network Center Advisory Board Annual Report 2000–2001. Lansing, Mich.: Michigan State University Extension Services, May 2001.

Lansing Network Center Advisory Board Annual Report 2001–2002. Lansing, Mich.: Michigan State University Extension Services, May 2002.

From Dialogue to Action: Recommendations for Increasing Access to Substance Abuse Prevention and Treatment Services. Lansing, Mich.: Mid-South Substance Abuse Commission, June 27, 2002.

Community Briefing 2002. Lansing, Mich.: Capital Area Health Alliance, September 2002.

Community Briefing 2004: Releasing the Power of People Who Care. Lansing, Mich.: Capital Area Health Alliance, September 2004.

The Power of We-Strengthening Community Connections for Action. Lansing, Mich.: Capital Area United Way and Ingham County Health Department, Fall 2002.

Lansing Network Center Advisory Board Annual Report 2002–2003. Lansing, Mich.: Michigan State University Extension Services, May 2003.

Ingham County Health Department Access to Health Project Evaluation. Lansing, Mich.: Public Sector Consultants Inc., January 2004.

World Wide Web Sites

www.CACVoices.org is the Web site of the Capital Area Community Voices program. It contains information about the four neighborhood network centers, W.K. Kellogg Community Voices program, and partner organizations. Project documents available at the Web site include: the Action Plan for an Organized System of Care in Ingham County, The Power of We-Strengthening Community Connections for Action, Community Briefing (2002), From Dialogue to Action: Recommendations for Increasing Access to Substance Abuse Prevention and Treatment Services, Community Briefing 2004: Releasing the Power of People Who Care, and the three Public Health Sector Consultants evaluation reports for RWJF, W.K. Kellogg and the Community Access Program.

Sponsored Workshops

"Beginning the Dialogue on Access to Healthcare in Ingham County," February 19, 1999, Lansing, Mich. Attended by approximately 155 community members. In four breakout sessions, participants revised four principles for forming an organizing system of care that were derived from the stakeholder interviews. At the forum, the project team presented a report (Setting the Community Table: The Stakeholders Speak on Access to Healthcare) which summarized interviews with 51 consumers, employers, providers and insurers who "told the story" of the uninsured from their perspective. Forum participants formulated five principles for developing the organized system of care based on their discussion of the report. (See Appendix 2 for a list of the principles.)

"From Dialogue to Action," November 23, 1999, Lansing, Mich. Attended by approximately 150 community members. In discussions and work sessions, participants developed preliminary action steps for an organized system of care in Ingham County. Participants based these steps on recommendations from 15 learning sessions following the February 19, 1999 Forum, which focused on three topics:

  1. who are the uninsured
  2. what services are available to them
  3. how are the services funded.

"Launching the Action Plan," February 22, 2001, Lansing, Mich. Attended by approximately 150 community stakeholders and members of the media. The Capital Area Health Alliance presented the completed Action Plan for an Organized System of Care in the Capital Area to the public and the press.

"Dialogue on a Structure for Maintaining Community Engagement," November 16, 2001, Lansing, Mich. Attended by members of the Human Services Advisory Committee and about 30 participants from the network neighborhood centers, school districts, hospitals and other community agencies. The group engaged in a facilitated discussion of the topic: What are some promising structure for pooling and managing support for the neighborhood and community engagement that has occurred through Ingham Community Voices?

"From Dialogue to Action: Increasing Access to Substance Abuse Services," June 27, 2002, Lansing, Mich. .Attended by service providers and consumers from the nine-county area served by the Mid-South Substance Abuse Commissioner. In a facilitated dialogue process, participants began creating an action plan for substance abuse based on recommendations in the report, From Dialogue to Action: Recommendations for Increasing Access to Substance Abuse Prevention and Treatment Services.

"Connecting Our Future to Health," September 17, 2002, Lansing, Mich. Attended by approximately 150 community members. The Capital Area Health Alliance presented the Community Briefing 2002 to the public.

"Releasing the Power of People Who Care," September 28, 2004, Lansing, Mich. Attended by approximately 250 community members. The Capital Area Health Alliance presented the Community Briefing 2004 to the public.

Presentations and Testimony

Doak Bloss, "The Ingham Health Plan: Using Community Will to Create Coverage for the Uninsured," at the Annual Meeting of the American Public Health Association, November 8, 2004, Washington. Abstract available online.

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Report prepared by: Jayme Hannay
Reviewed by: James Wood
Reviewed by: Marian Bass
Program Officer: Pamela Dickson
Program Officer: Rush Russell

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