Promising Initiatives

The Colorado Health Report Card is designed to provide reliable measures of Colorado’s movement toward becoming the healthiest state in the nation. It is also intended to motivate individuals, organizations and policymakers to take the next steps needed to improve our performance. To this end, we have identified a number of initiatives and/or programs in Colorado and elsewhere that illustrate positive action steps made by public and private organizations toward improving population health.

In the selection of these initiatives, we have highlighted those that offer innovative approaches to change; some have been formally evaluated, others have not. Many of the initiatives are relatively new and therefore do not have an established track record, yet they are indeed promising.

• Healthy Beginnings 
• Healthy Children
• Healthy Adolescents
• Healthy Adults
• Healthy Aging

Promising Initiatives for Healthy Beginnings

Prenatal Care
B4 Babies & Beyond in Mesa County is a program that provides prenatal education and access to early and comprehensive prenatal care while serving as an out-station eligibility site for enrolling qualified low-income pregnant women in Medicaid and Child Health Plan Plus (CHP+).¹ The program also enrolls newborns in the Medicaid and CHP+ programs. Established in 1990, this program is now one of 23 community-based programs managed by a Grand Junction-based nonprofit, Hilltop Resources. Approximately 47 percent of all pregnant women in Mesa County are served through the program, and 100 percent of physicians and certified midwives who deliver babies in the region participate in the program. In 2008, approximately 1,000 pregnant women and 800 newborns gained health care coverage through B4 Babies.

Since the program’s inception, a primary goal has been to lower access barriers to health care for low-income pregnant women. To help meet that goal, all services provided through the program are free of charge for women who are not eligible for CHP+ or Medicaid. Program participants receive any or all of the following services: application assistance and screening for Medicaid and CHP+ eligibility; issuance of temporary insurance cards; assistance with finding a physician and setting up prenatal appointments and information about healthy choices to make during pregnancy. Participants can also get help with referrals to community resources, translation and transportation services when needed.

Smoking While Pregnant
In 2006, a smoking cessation program in Mesa and Chaffee counties called Baby & Me Tobacco Free was established through grants from the March of Dimes and Rocky Mountain Health Plans Foundation. The aim of the program is to reduce the number of low birth weight babies in these counties by reducing the number of women who smoke during and after pregnancy.² Pregnant smokers who are referred to the program by their physician, clinic or local health department complete smoking cessation counseling and carbon monoxide (CO) testing at a county health department or other agency. After giving birth, they return monthly for carbon monoxide monitoring. Every month a mother remains tobacco-free, she receives a $25 voucher for diapers up to one year after delivery.

Plans to expand the program have been made possible through funding from the Colorado Health Foundation. In 2008, new programs were established in 18 counties and an additional 23 counties will have programs in place in 2009, with expansions to the remaining Colorado counties planned for 2010. Initial results from the Mesa County program show 55 percent of participants remained smoke free throughout their pregnancy and approximately 100 women who delivered tested negative for smoking at delivery. At present, close to 400 participants are participating in the program beyond Mesa County.

Low Birth Weight
Prenatal Plus, a program that targets high-risk, Medicaid-eligible mothers, aims to reduce low birth weight babies by providing case management, nutrition and psychosocial services to pregnant women. Established in Colorado in 1996, Prenatal Plus provides services that complement medical prenatal care by addressing the lifestyle, behavioral and non-medical aspects of a woman’s life that are likely to affect her pregnancy. This program is jointly administered by the Colorado Department of Public Health and Environment and the Department of Health Care Policy and Financing.³

In 2007, approximately 1,900 women received Prenatal Plus services across 21 provider sites in Colorado. This evidence-based program has been shown to reduce the number of low birth weight babies born to targeted mothers and provide cost savings to the Medicaid program. A recent study found six out of 10 (61 percent) program participants were able to mitigate their identified risk factors before delivery, resulting in a low birth weight rate well below the state average (7.2 percent vs. 9.0 percent).⁴ A cost-effectiveness study conducted in 2002 found that for every $1 spent on Prenatal Plus services, $2.48 was saved in Medicaid costs through the first year of the infant’s life.⁵

Infant Mortality
In 1991 the Health Resources and Services Administration of the U.S. Department of Health and Human Services funded 15 urban and rural sites in communities with infant mortality rates that were 1.5–2.5 times the national average to launch the Healthy Start initiative. This initiative has now grown to include 96 federally funded Healthy Start programs nationwide that have demonstrated significant reductions in preterm births and low birth weight rates in Healthy Start communities. Communities have flexibility in designing a program that meets their unique needs, provided they can demonstrate decreased infant mortality rates and provision of adequate prenatal care; promotion of positive prenatal health behaviors; helping women and children meet their basic health needs (nutrition, housing, psychosocial support); and reducing access barriers to health care.⁶

The Healthy Start program in Aurora works to address the significant health disparities in infant mortality rates between black births and all others. A local partnership including the Tri-County Health Department, local elected officials, black sororities, clinicians, participants from Arapahoe County Human Services, the Metro Community Provider Network and the Colorado Chapter of the March of Dimes was formed to target high-risk women in Aurora before they get pregnant and then support them through the prenatal period and after delivery with medical and supportive services that reduce risks and lower infant mortality rates within the black population.⁷

Immunizations
Salud Family Health Center in Fort Lupton, Colorado, initiated an immunization outreach program in 2002 to increase immunization rates among low-income, rural children. Reminder cards were given to patients in their primary language and posters were placed in clinic exam rooms reminding parents and physicians to vaccinate children while in the clinic for any visit. Up to three reminder cards were sent to parents of all children seen in select pediatric clinics.⁸

Evaluation of the outreach program found immunization rates increased from 61 percent at the start of the intervention to 73 percent at termination (nine months later). This change represented an increase in all antigens, with the most significant increase in the H. influenza type B vaccine. The reminder cards sent to parents encouraging them to stay on track with their child’s immunization schedule were found to be effective with one fully immunized child for every eight children receiving a recall card.

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Promising Initiatives for Healthy Children

Uninsured
In 2009, The Colorado Trust committed $4.5 million over three years to fund 14 safety net providers across Colorado (community clinics, federally qualified health centers, school-based health centers and local public health departments) through an Expanding Access to Health Care for Children grant program. Various strategies are being employed by the grantees to meet the program goal including hiring new clinical and outreach staff and ensuring that efficient referral networks are in place in their community to improve continuity and comprehensiveness of health care services for children. In an effort to better understand the impact grantees are making on the populations they serve, all grantees are required to participate in the Safety Net Indicators and Monitoring System hosted by the Colorado Health Institute. The SNIMS was established in 2005 to monitor the sustainability and capacity of Colorado’s health care safety net to meet the physical, mental and oral health primary care needs of vulnerable Coloradans.⁹

Poverty
The Harlem Children’s Zone (HCZ) has developed a comprehensive and holistic approach to combating childhood poverty in New York City by responding to the social, health and educational needs of low-income children and their families. The HCZ began as a one-block pilot in the 1990s in a neighborhood with high rates of childhood poverty (39 percent) and has now expanded to 60 city blocks in Harlem. The HCZ model is based on five core principles: engage the entire neighborhood to transform the physical and social environment in which children grow and develop (culture change); create a pipeline of support through programs inside and outside the schools that link children, their families and the community in an uninterrupted support network; build community partnerships between residents, institutions and stakeholders to create a healthy environment; evaluate program outcomes and build in an informed outcomes-based decision-making process; and reinforce a culture of success based on accountability, teamwork and community leadership.¹⁰

One of the main goals of the HCZ is to intervene as early as possible in the lives of children by laying the foundation for healthy growth and development and ensuring that children are fully engaged in success-oriented activities as they grow. Baby College is one strategy that includes workshops for expectant parents and those with infants up to 3 years old. The “college” provides parents with the skills and knowledge necessary to raise healthy children in a healthy environment. There are also school-based programs for all children between preschool and senior high school. A related goal is to educate parents about what it takes to help their children succeed. Activities such as community-based coalitions to improve housing conditions and assist families to access counseling, financial and legal services are integral to the program.

Medical Home 
Recognizing that a medical home is more than a relationship between a patient and a medical office, Project HEALTH exists as an exemplary medical home model for vulnerable families and children. Founded in the Boston Medical Center Pediatrics Department in 1996, Project HEALTH trains and relies upon undergraduate volunteers to improve the health of low-income children and their families by serving as navigators and facilitators between families and community-based resources. Over 600 trained volunteers serve at “family help desks” located in urban prenatal and pediatric clinics, newborn nurseries, emergency rooms and community health centers in several U.S. cities—Boston, Providence, New York, Baltimore, Washington, D.C. and Chicago. At these clinical sites, physicians “prescribe” food, housing, job training, GED classes and any other resources needed to meet a family’s social and educational needs. The college volunteers work alongside families to “fill” the prescriptions by connecting them to the prescribed resources. Since 1996, Project HEALTH’s 16 family help desks have served over 14,500 children and adults. Approximately 4,000 families are served annually.¹¹

Preventive Dental Care 
Cavity Free at Three is a Colorado-based early childhood caries prevention program for low-income families that employs evidence-based strategies to prevent the transmission of bacteria between mothers and infants and provide early preventive oral hygiene experiences for infant’s ages birth to 3 years. This statewide effort engages dentists, physicians, nurses, dental hygienists, public health practitioners and early childhood educators to increase access to oral disease prevention and early caries detection for low-income pregnant women and their children. The program provides free oral health materials to pregnant women and new mothers and technical assistance to a range of health care providers in the oral health screening of mothers and their newborns.¹²

Since the program began in 2006, 10 Colorado communities have received grants through the Cavity Free at Three program totaling $1.5 million over five years. The program is jointly funded by Caring for Colorado Foundation, the Colorado Health Foundation, The Colorado Trust, Delta Dental of Colorado Foundation, Kaiser Permanente and Rose Community Foundation. In its first year, more than 400 medical providers including dentists, dental hygienists, physicians and public health nurses were trained in the train-the-trainer model. More than 300 parents have been educated and their infants and toddlers screened and received fluoride varnishes. Plans are underway to expand the program to additional communities and thereby reach approximately 40,000 children throughout Colorado by 2011.

Vigorous Exercise 
Safe Routes to School (SRTS) is a national program that creates safe, convenient and fun opportunities for children to bicycle and walk to and from school by improving sidewalks and traffic safety. The national SRTS program is federally funded and the management and administration of the program is delegated to state departments of transportation.¹³

In Colorado, funds have been distributed to school districts, schools, cities, counties, state and tribal entities for projects that encourage physical activity opportunities for students in grades K-8 as they travel to and from school. Nonprofits are required to partner with a state subdivision to apply for funding.

One promising Colorado SRTS program is based in Boulder. In 2007, the City of Boulder received $193,000 from SRTS to improve sidewalks, paths and ramps, and Boulder Valley Schools received an additional $36,000 to promote physical activity programs. Foothill Elementary in the Boulder school district used the grant to expand “Walk and Wheel Wednesdays,” a program developed in 2005 designed to increase students’ interest and participation in walking or biking to school. The school also made infrastructure improvements to increase pedestrian and bicycle safety on sidewalks and crosswalks. Between November and May of the 2006–2007 school year, the number of students walking and bicycling to school increased by 8 percent.¹⁴

Obesity 
In 1998, the U.S. Department of Agriculture (USDA) launched a childhood obesity prevention initiative through the Women, Infants and Children Supplemental Nutrition Program (WIC) called FIT WIC. Five FIT WIC projects were funded over three years in California, Kentucky, Vermont, Virginia and the Inter Tribal Council of Arizona. Each project team developed tailored programs to increase healthy eating behaviors and physical activity levels among their WIC participants.¹⁵

In Vermont the WIC program serves half of all pregnant women and infants in the state and about 35 percent of all children under the age of 5 years. The Vermont FIT WIC project developed the “FIT WIC Activity Kit” to increase active physical playtime and decrease sedentary time for 3- and 4-year-olds. WIC mothers were given an activity kit with information about the important relationship between cognitive and physical development, ideas for incorporating physical activity into everyday routines, specific skill-building activities designed to enhance physical development and learning among young children and information about active community resources for family outings.

Within two weeks of receiving the activity kit, almost three-fourths of WIC mothers reported using it at least four times throughout the week. WIC mothers also reported increased confidence in their ability to teach play skills to their children and increases in the time their child spent in active play throughout the day.

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Promising Initiatives for Healthy Adolescents

Uninsured
School-based health centers (SBHCs) are clinics located in schools or on school grounds designed to improve access to primary health care, reduce absenteeism, reduce emergency department utilization and improve age appropriate screening and immunizations for children up to the age of 18 years. SBHCs are staffed primarily by nurses who utilize a multi-disciplinary approach to primary care by coordinating with behavioral health specialists and oral health professionals when available.¹⁶

During the 2007–2008 academic year, 18 SBHC programs operated 44 clinic sites in schools across Colorado. Approximately 26,650 children and adolescents in Colorado were served, 50 percent of who were uninsured.

Poverty
House Bill 09-1243 was signed into law in May 2009 for the purpose of supporting schools that implement evidence-based solutions to reduce high school dropout rates. The legislation creates an Office of Dropout Prevention and Student Re-engagement in the Colorado Department of Education which is responsible for identifying school districts with high dropout rates and providing them targeted assistance. The bill also establishes a grantmaking program to help school districts provide educational services to engage students at risk of dropping out.¹⁷

An example of one evidence-based dropout prevention program is the Leadership and Resiliency Program implemented in Fairfax, Virginia. This community-based program for high school students ages 14 to 17 focuses on reinforcing individual strengths while preventing opportunities for engaging in substance abuse and violence. Alternative activities include weekend outdoor expeditions, volunteer community service and after-school support groups.¹⁸

Nutrition
The Farm to School Initiative, led by Healthy Lifestyle La Plata, a LiveWell community, connects schools with local farms and ranches with the objective of serving healthy meals in school cafeterias and improving student nutrition and healthy eating habit education. The initiative began in 2005 when the Durango 9R School District started buying local produce for special events. The program has expanded to two other school districts in the county where 11 local food producers supply locally grown foods to the schools.¹⁹ In an effort to make high-quality, fresh produce available to schools at a reasonable price, the district allocated an additional $500 per school from the existing food budget to purchase locally produced foods.

National evaluations of similar farm-to-school initiatives find that students’ knowledge about healthy eating and locally grown foods increases significantly when fresh produce is available in the school cafeteria. In turn, healthy eating at school has a positive effect on the food purchasing behavior of parents who report a greater awareness of the nutritional value of fresh fruits and vegetables in the diet.²⁰

Vigorous Exercise
Sports4Kids was developed in Berkeley, California, in 1995 to engage children and adolescents in physical activities during and after school hours. The program now serves more than 65,000 students in 170 low-income public schools in Baltimore, Boston, New Orleans, the greater San Francisco Bay Area, St. Louis and Washington D.C. The Robert Wood Johnson Foundation recently teamed up with Sports4Kids to provide expansion funding to reach one million children and adolescents by 2010.

Sports4Kids addresses the whole child (physical, emotional and cognitive) through coordinated physical activity during lunchtime, recess and after school. It is offered in public schools with 50 percent or more students who are eligible for free or reduced-price lunches. A 2006 survey of school principals found that 94 percent believed their students were more physically active since Sports4Kids was implemented in their school. Additionally, 70 percent reported that there were fewer playground fights than the previous year and 61 percent of teachers said students were more focused in the classroom.²¹

Binge Drinking
Girls Circle, a structured support group for girls ages 9–18 years, provides skills training designed to increase positive social relationships and develop skills that promote self-esteem and competency across a range of life skills. Facilitators work with small groups of girls to build these competencies and counteract the negative forces that impede healthy growth and development. Girls Circle is recognized as a “promising approach” by the federal Office of Juvenile Justice and Delinquency Prevention. Plans are underway to implement this evidence-based program across several counties in Colorado at local health departments, mental health centers, high schools and juvenile justice districts.²²

A 2006 evaluation study of 278 girls from 19 cities across the United States found statistically significant improvements in self-harming behaviors and alcohol use and increased attachment to school.

Smoking
The FixNixer Web site was launched in Colorado in 2004 to help adolescents and adults find successful smoking cessation resources. The Web site assists users in developing a customized plan to quit smoking and set realistic goals, including a quit date; it is anonymous, free and includes an online community forum and QuitBlog.

FixNixer.com is sponsored by the Tobacco Education and Prevention Partnership of the Colorado Department of Public Health and Environment and is funded by the Amendment 35 tobacco excise tax.²³

Depression
Check Your Head, a program of Mental Health America of Colorado, uses hip hop as an intervention to address such issues as self-identity, peer pressure, depression and suicide among high school students. The program engages youth through a dedicated Web site, community events, and classroom and after-school clubs to educate youth about a range of mental health issues and linking them to accessible mental health resources.²⁴

Check Your Head is currently being offered at East and Montbello High Schools in Denver. In 2009, 60 students at Montbello and 30 at East High School participated in the program.

Funding is provided through the Tony Grampsas Youth Services Program, a statutorily authorized program in the Child, Adolescent and School Health Unit of the Colorado Department of Public Health and Environment.

Attempted Suicide 
A grassroots community effort in Jefferson County started in 2002 has grown into the Second Wind Fund. The program collaborates with schools to identify and get help for students at risk of suicide and helps connect them to mental health providers that provide free or reduced-fee counseling services. Currently, the Second Wind Fund has a network of more than 60 mental health providers who have agreed to be affiliated clinicians across the Denver Metro Area (Adams, Arapahoe, Broomfield, Denver, Jefferson and Park counties). Efforts are underway to expand the network to Douglas, El Paso, Mesa, Boulder and Teller counties. Second Wind affiliates have provided services to nearly 1,700 youth and project serving nearly 500 more in the 2009-10 school year.²⁵

Sexually Active 
¡Cuídate! (Take Care of Yourself) is a cultural-based intervention to reduce HIV risk among Hispanic youth. The intervention consists of six 60-minute modules delivered to small groups of teens. Through role playing, videos, music, interactive games and hands-on practice, ¡Cuídate! teaches teens about HIV, identifies prevalent attitudes and misinformation about HIV, safe sex and teaches correct condom use while negotiating abstinence and safer sex practices. The program incorporates aspects of Hispanic culture and how cultural beliefs frame discussions about abstinence, condom use and prevention of sexually transmitted diseases.²⁶

Denver Area Youth Services recently received funding from the Centers for Disease Control and Prevention to implement the ¡Cuídate! curriculum at Lincoln High School and then to expand it to Bryant Street Academy in Denver.

Condom Use
Safer Choices is a two-year, school-based, sexually transmitted disease and teen pregnancy prevention program that aims to educate adolescents about unprotected sex while encouraging abstinence and condom use among sexually active teens. The program includes a classroom curriculum coupled with schoolbased activities. It was recently identified as a “program that works” by the Centers for Disease Control and Prevention. This evidence-based program is currently being implemented in Colorado through Planned Parenthood of the Rocky Mountains.²⁷

An evaluation conducted in 20 high schools in California and Texas found the program was effective at increasing contraceptive and condom use among students enrolled in the program. Sexually active teens were almost twice as likely to use birth control and condoms or condoms alone after completing the program. Further, Hispanic youth were significantly more likely to delay initiation of sexual activity compared to those not involved in the program.

Teen Fertility 
Making Proud Choices! is an eight-module curriculum that empowers young adolescents to decrease pregnancy risk by developing skills to negotiate abstinence and safe sex practices such as condom use. Through the curriculum, teens are educated about practical ways they can reduce their risk of becoming infected with HIV and other STDs and also the risk of pregnancy. The program has been found to be especially effective with sexually active teens who were active when they started the course.²⁸

The Making Proud Choices! curriculum is usually implemented with small groups ranging from 6-12 participants, but it can be adapted to larger groups. The Colorado Organization on Adolescent Pregnancy, Parenting and Prevention conducts trainings for teachers, health educators and other community members who plan to implement the program in various community settings including schools and youth services agencies. Durango School District recently went through the Making Proud Choices! training in August 2009 and plans are underway to implement the curriculum.²⁹

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Promising Initiatives for Healthy Adults

Uninsured
Access Health is a coverage program developed by the Muskegon Community Health Project in Michigan. It is a successful community-based approach to expanding health care coverage to uninsured workers that is based on a “three share” funding model between employers, employees and the community wherein each contributes roughly 30 percent toward cost of coverage. Workers only qualify if they are low income, uninsured and live and work in Muskegon County. Likewise, businesses qualify only if they are located in the county and have not provided health benefits for the past 12 months. Over 526 local businesses have participated in Access Health since the program began in 1999 and over 1,500 previously uninsured workers have received coverage.³⁰

Health Access Pueblo (HAP), implemented in 2008, is modeled after Access Health through a partnership between Parkview Medical Center, St. Mary Corwin Medical Center, Pueblo Community Health Center, Pueblo County, participating health care providers and local businesses. HAP contracts with 200 local physicians and covers only workers in Pueblo. With a monthly premium of $120 per qualified employee, HAP is not insurance but rather a local coverage initiative. Enrollees have access to hospitalization benefits and no-cost or low-cost preventive care, diagnostic services and wellness counseling.³¹

Medical Home 
The Safety Net Medical Home Initiative is a newly implemented program in Colorado that assists safety net clinics in implementing and sustaining patient-centered medical homes and reaching identified benchmarks for quality and efficiency. Over a period of four years, participating clinical sites will work on eight “change areas” that include linking patients to a consistent clinician and support team; putting quality improvement structures and quality improvement teams in place; providing care that is respectful, culturally sensitive and involves the patient in decision making; and using evidence-based care protocols such as clinical guidelines for specific chronic diseases. Patients will be linked to community resources and have 24-hour access to care. Care providers will share information and assist patients in obtaining health care coverage for which they are eligible.³²

The initiative was launched by the Commonwealth Fund, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute. In Colorado, the Colorado Health Foundation provided funding to the Colorado Community Health Network which is managing the project and providing technical assistance to clinical sites. Participating Colorado sites include Clinica Family Health Services (Boulder, Pecos and Thornton clinics), Custer County Clinic, Denver Health (Eastside, La Casa/Quigg Newton and Sandos Westside clinics), High Plains Community Health Center, Inner City Health Center, Metro Community Provider Network (Jeffco Clinic), Mountain Family Health Centers (Glenwood Springs), Valley Wide Health Systems (Sierra Blanca and Alamosa Family Medical Centers) and the Yuma Rural Health Center.

Nutrition
The Centers for Disease Control and Prevention (CDC) instituted a 5 A Day for Better Health initiative in 1991 to promote increased consumption of fruits and vegetables to 5–9 servings every day and to inform Americans of the health benefits of doing so. The initiative is a public awareness campaign that includes educational materials for communities and individual consumers. Since its inception, the CDC reports that the percentage of Americans who are aware of the recommended five or more servings of fruits and vegetables a day has increased nearly five-fold.³³

In Colorado, a 5 A Day for Better Health coalition was formed in 2004 with assistance from the Colorado Department of Public Health and Environment and is promoted in partnerships around the state through the Colorado Physical Activity and Nutrition Program. COPAN has helped develop a Produce Festival Tool Kit that is distributed to grocery stores and retailers, encouraging them to hold nutritional education events and health fairs. The fairs are designed to increase consumers’ comfort level in the produce area of the grocery store, including sampling fruit and vegetable recipes, providing recipes and tips to working up to five servings of fruits and vegetables a day. Since 2004, more than 200 school and business-related health fairs have been held in Colorado to educate communities about important nutrition information.³⁴

Exercise
The Colorado Physical Activity and Nutrition Program developed a worksite resource kit that includes nutrition and physical activities designed to be carried out free or at little cost to employers. Strategies focus on health education, physical activity, healthy eating, the worksite environment and exercise-related factors that contribute to or exacerbate chronic disease.³⁵

Since 2003, more than 500 worksite resource kits have been distributed and over 150 people currently participate in the Colorado Worksite Health Promotion listserv. Worksite wellness grantees have included Aims Community College in Greeley, Choice Hotels International in Grand Junction, Denver Department of Human Services, Denver Health & Hospital Authority and Mountain States Employers Council.

Obesity
In addition to its work on nutrition, the Colorado Physical Activity and Nutrition Program supports the Active Community Environment (ACE) Task Force that focuses on the built environment and its effect on engaging residents in healthy behaviors. ACE represents government, public health, transportation officials, and local planners and designers. Members support local planning efforts to modify existing environments in ways that make it easy for people to integrate physical activity into their daily routines.³⁶

Strategies to achieve change include assessing, modifying and improving community planning and design efforts to support increased physical activity; land-use planning to integrate “smart growth” principles; developing school sites that promote active community living; developing integrated parks and open space with recreation facilities near neighborhoods and employment centers; and developing a balanced transportation system that includes transit, walking, bicycling and motor vehicles.

ACE activities include sponsoring regional workshops for key stakeholders and an annual conference of active living leaders in Colorado. In addition, the task force provides materials to organizations to help facilitate the inclusion of public health principles in transportation and land-use master plans.

Current Smokers 
The Colorado QuitLine provides a variety of services to Colorado residents age 15 and older who want to stop using tobacco. Included in the free online service are support from a team of coaches, research-based information and connecting people who are trying to quit smoking. Coaches assist QuitLine members with overcoming common obstacles such as stress, tobacco cravings, irritability and weight gain. In addition to the online resources, Colorado residents can call a toll-free number to speak with a coach and receive free nicotine patches if eligible (at least 18 years old).³⁷

Every month, the QuitLine serves approximately 3,800 people. The service and other prevention and intervention programs aimed at reducing smoking are supported through Amendment 35 funds.

Binge Drinking
Healthy Workplace is a program designed to reach at-risk employees before they become dependent on or abuse alcohol or drugs. There are five separate but related Healthy Workplace interventions that target unsafe drinking, illegal drug use, abusing or misusing prescription drugs and promotion of healthy lifestyle practices. Intervention materials are designed to raise awareness of the hazards of substance use and the benefits of healthy behaviors and to provide workers with techniques to combat substance abuse. Provided in a de-stigmatizing atmosphere, the intervention is delivered in small-group sessions using videos and print materials. This program has been replicated across many sites and is included in the Substance Abuse and Mental Health Services Administration registry of evidence-based programs.³⁸

Poor Mental Health
The Community Mental Health and Substance Abuse Partnership in Larimer County was established in 1999 with the goal of re-designing and improving the evaluation and treatment of individuals with mental health problems and addictive behaviors in Larimer County. A historically fragmented delivery system is now a model of successful integration in which 34 organizational providers and many individual providers—among them governmental agencies, nonprofit organizations, hospitals, private practitioners, police officers, school teachers, school counselors, clergy and mental health advocates—collaborate with one another to improve access to mental health and substance abuse services for an estimated 60,000 residents in the county.³⁹

The partnership was developed under a grant from the Local Initiative Funding Partners program, a collaborative effort of the Robert Wood Johnson Foundation and Colorado-based foundations. Additional funding has been made available through the County Health District, 14 community partners and eight local matching funders. Through these funding commitments, residents now have access to comprehensive crisis intervention and after-hours care as well as primary care at safety net clinics.

Diabetes
Por Tu Familia (For Your Family) is a program sponsored by the American Diabetes Association (ADA)-Colorado to increase awareness about the risks associated with cardiovascular disease and diabetes and to promote healthy lifestyles. Special emphasis is placed on serving low-income, uninsured Hispanics.⁴⁰

Through Por Tu Familia, the ADA provides diabetes information in English and Spanish to a community disproportionately affected by diabetes. Informational exhibits deliver explicit, culturally relevant messages to the Hispanic community in such venues as health fairs, festivals, parades and other Hispanic celebrations around Colorado.

Registered dieticians, nurses, nutritionists, certified diabetes educators and other health care professionals conduct lifestyle change classes in 26 Colorado counties at 41 medical clinics (mainly community health centers) through the Por Tu Familia program.

Evidence-based research has demonstrated that the program improves heart healthy behaviors, promotes referrals and screenings and enhances information sharing beyond families into the community. More than 4,000 Hispanics attended a Diabetes Expo in Colorado in 2009.

High Blood Pressure 
LiveWell Weld County is a broad-based coalition funded by LiveWell Colorado. The intervention is a five-year project focused on healthy eating, physical activity and smoking cessation to positively affect high blood pressure and overall cardiovascular health. LiveWell Weld County focuses on cardiovascular health through the Heart of Weld Project which seeks to reduce risk factors for cardiovascular disease among low-income women ages 40 to 64 years who are under- or uninsured.⁴¹

Regular screenings include height, weight and blood pressure measurements and cholesterol and glucose monitoring. Women identified as moderate-to-high risk for developing heart disease are encouraged to enroll in a lifestyle intervention program. All screenings and the lifestyle intervention program are provided to eligible women without cost.

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Promising Initiatives for Healthy Aging

Medical Home 
The Colorado Multi-Payer, Multi-State Patient-Centered Medical Home (PCMH) project was launched in 2009 in 16 medical practices across Colorado’s Front Range. The primary goal of this two-year pilot program is to test the provision of comprehensive, coordinated care for adults and seniors through formal partnerships between patients and their personal health care team.⁴²

To enable medical practices to create an “integrated medical neighborhood,” the PCMH project will rely on a payment model that includes a monthly care management fee to the health care team and a bonus for meeting or exceeding specified quality outcomes. The pilot will shift the focus away from illness care toward comprehensive prevention and early intervention-oriented care.

The pilot began in spring 2009 and anticipates enrolling up to 30,000 patients covered by Anthem Wellpoint, United Healthcare, Humana, Aetna, CIGNA, Colorado Medicaid and Colorado Access. Funding has been provided by the Commonwealth Fund and The Colorado Trust. The Colorado Clinical Guidelines Collaborative will provide technical assistance and serve as the convening organization for the pilot. An evaluation will determine the effects on quality, cost and satisfaction levels of both patients and providers.

Immunizations
Minnesota’s Mark of Excellence program was launched in 2006 to increase public confidence in flu vaccinations administered in nonmedical settings such as grocery stores, pharmacies and workplaces. The state Department of Health provides education and instructions for how to store, handle and transport vaccines safely and how to properly give and document vaccines to these non-clinic-based sites. Those that successfully complete the training receive a Mark of Excellence seal to publicly display. Consumers can check a “Find a Flu Shot Clinic” Web site to find locations with the Mark of Excellence seal of approval.⁴³

Exercise
The Colorado Department of Public Health and Environment (CDPHE) partnered with the University of Colorado Health Sciences Center in 2001 to create a statewide physical activity and nutrition program to prevent obesity called Colorado on the Move. The program promotes community-based programs that encourage small behavioral changes over time to achieve long-term healthy results. Participants are encouraged to walk 2,000 steps a day, using pedometers or step counters to measure their progress. Each site is asked to develop a 14-week program with incentives for its participants. Depending on the individual site, pedometers may be provided either free of charge or at a reduced cost.⁴⁴

The program was initially implemented in two communities—a rural site and the Denver Metro Black Church Initiative, a faith-based community of 20 churches. This walking program has been expanded to more than 50 work sites and 12 communities across Colorado, and is part of the state plan to address obesity. It also served as the pilot site for America on the Move, a national version of the program.

Poor Physical Health
LiveWell Wheat Ridge staff and the Jefferson County extension nutrition educator have developed the Bridge on the Bus program to combat health issues related to poor nutrition in older adults. The program assists participants in gaining access to healthy foods at nearby grocery stores and discusses healthy eating habits. Once a week during the fall and winter months, LiveWell Wheat Ridge staff accompanies participants to local grocery stores and provide education on a variety of nutrition and food resource management topics.⁴⁵

Participants report saving money on their weekly grocery bills and increased awareness of what to look for in the ingredients listed on nutrition labels.

Poor Mental Health 
The University of Washington’s Health Promotion Research Center has developed the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) with funding from the Centers for Disease Control and Prevention. This evidence-based program is currently being implemented in Colorado Springs through the community mental health center and clinicians in private practice. PEARLS was designed for adults ages 60 and older who have chronic minor depression and who receive home-based social services from community agencies to reduce symptoms of depression and improve their quality of life.⁴⁶

Trained social service workers provide PEARLS participants with eight 50-minute sessions over a 6-month period. Sessions take place in the participants’ homes and focus on three primary depression management techniques: 1) problem-solving in which clients are taught to recognize depressive symptoms, define problems that may contribute to the symptoms and then devise steps to resolve them; 2) planning for social and physical activities; and 3) participating in social events.

Limited Activity
The Senior Fall Prevention Program in Broomfield provides free comprehensive injury prevention assessments that focus on general health, nutrition, physical activity and environmental risks for residents living in senior housing complexes. Broomfield Greens, a senior living center, utilizes a local resident to lead two exercise classes each week that combine balance, relaxation and strength training. These classes have proven to engage formerly sedentary 70–90+ year-old seniors living in the complex. LiveWell Broomfield has been working to expand these types of classes to other sites by supporting “internal champs” who can then lead peers in healthy living activities, thus creating small changes to the environment that encourage physical activity.

Since beginning the fall prevention program in 2002, Broomfield Health and Human Services in partnership with Home First, Inc. and Senior Services has provided over 275 risk assessments to residents 65 years and older.⁴⁷

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Footnotes:

1. Hilltop, B4 Babies & Beyond.
2. Rocky Mountain Health Plans Foundation.
3. Prenatal Plus, Colorado Department of Public Health and Environment.
4. Colorado Department of Public Health and Environment. (2007). “Prenatal Plus Annual Report.”
5. Colorado Department of Public Health and Environment. (2002). “The Effects of the Prenatal Plus Program on Infant Birth Weight and Medicaid Costs.”
6. Healthy Start Association.
7. Aurora Healthier Beginnings, Aurora Healthy Baby Initiative.
8. Paul, H., MD, et al. “Reminder Cards and Immunization Rates Among Latinos and the Rural Poor in Northeast Colorado.” Journal of the American Board of Family Medicine; Vol. 20(6): 581-586; 2007.
9. The Colorado Trust.
10. The Harlem Children’s Zone.
11. Project HEALTH.
12. The Colorado Trust.
13. National Center for Safe Routes to School.
14. Colorado Department of Transportation, Safe Routes to School Program.
15. The Center for Weight and Health, FIT WIC.
16. Colorado Association for School-Based Health Care.
17. Colorado House Bill 09-1243, Dropout Prevention and Student Re-engagement.
18. U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
19. U.S. Department of Agriculture, Cooperative State Research, Education and Extension Service.
20. LiveWell Colorado.
21. Sports4Kids.
22. Girls Circle.
23. Colorado Department of Public Health and Environment.
24. Mental Health America of Colorado.
25. Desai, R., et al. “Mental health service delivery and suicide risk: The role of individual patient and facility factors.” American Journal of Psychiatry. 162(2): 311-318; 2005.
    
    Second Wind Fund.
    
    
26. Centers for Disease Control and Prevention (CDC), Best Evidence, ¡Cuídate! (Take Care of Yourself).
    
    Denver Area Youth Services.
    
    
27. Coyle, K., et al. “Safer choices: Reducing teen pregnancy, HIV and STDs.” Public Health Reports. 116: 82-93; 2001. Colorado Organization on Adolescent Pregnancy, Parenting and Prevention.
28. Resource Center for Adolescent Pregnancy Prevention, Evidence-based programs.
29. Colorado Organization on Adolescent Pregnancy, Parenting, and Prevention.
30. Muskegon Community Health Project.
31. Health Access Pueblo.
32. Qualis Health. The Safety Net Medical Home Initiative.
33. Centers for Disease Control and Prevention, Fruits and Veggies Matter.
34. Colorado Department of Public Health and Environment, 5 A Day for Better Health.
35. Colorado Department of Public Health and Environment, Colorado Physical Activity and Nutrition Program, Worksite Task Force Strategies.
36. Colorado Department of Public Health and Environment, Colorado Physical Activity and Nutrition Program. Active Community Environments.
37. Colorado Department of Public Health and Environment, Colorado QuitLine.
38. Substance Abuse and Mental Health Services Administration (SAMHSA), National Registry of Evidence-based Programs and Practices.
39. Health District of Northern Larimer County.
40. American Diabetes Association, Featured Projects.
41. LiveWell Weld County.
42. Colorado Clinical Guidelines Collaborative. The Colorado Multi-Payer, Multi-State Patient-Centered Medical Home Pilot Overview.
43. Minnesota Department of Health Mark of Excellence.
44. America on the Move.
45. LiveWell Colorado.
46. Centers for Disease Control and Prevention, Prevention Research Centers.
47. LiveWell Colorado.