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. Some 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
CenteringPregnancy, established in 1993, helps women get prenatal care by incorporating health assessments, education and support into a single program. A small group of pregnant women with similar due dates meets to gain care skills, participate in facilitated discussion and build a support network. Each CenteringPregnancy group is led by a certified prenatal care provider and a co-facilitator. The group meets 10 times throughout the women's pregnancy and early postpartum. That time is split between discussions and information sharing, and each woman also has three-five minutes to be examined by a care provider. Much of the success of CenteringPregnancy is created by the women who participate. Along with facilitators, the women are motivated by one another to choose healthful behaviors such as eating more nutritious food and breastfeeding. Women empathize with their peers as they face similar challenges in their pregnancies.

A 2009 study suggests individuals participating in CenteringPregnancy had significantly more prenatal care visits, gained more weight during pregnancy, were more likely to initiate breastfeeding and reported being more satisfied with their care than women in traditional prenatal care. CenteringPregnancy is offered in 15 locations across Colorado.¹

Smoking While Pregnant
A smoking cessation program called Baby & Me – Tobacco Free was established in 2006 by the March of Dimes and the Rocky Mountain Health Plans Foundation. Pregnant women who smoke are referred to the program by their physician, clinic or local health department. They complete smoking cessation counseling and carbon monoxide testing to determine smoking status. After giving birth, the women participate in follow-up appointments to monitor their carbon monoxide level. Every month a mother remains tobacco-free, (up to one year after delivery) Baby & Me – Tobacco Free gives her a $25 voucher for diapers.

Program expansions have been made possible through funding from the Colorado Health Foundation and the Rocky Mountain Health Plans Foundation. Baby & Me – Tobacco Free is now available at 52 sites, serving women from 49 Colorado counties. Approximately 66 percent of participants are able to quit smoking during their pregnancy. Since 2006, Baby & Me – Tobacco Free has served more than 2,550 women throughout Colorado.²

Low Birth Weight
The Nurse-Family Partnership helps at-risk first-time mothers and their babies. Registered nurses visit women regularly in their homes to provide care and support to help them give birth to healthy babies and develop parenting skills. These visits occur from early pregnancy until the child's second birthday, allowing time for the nurse to form a close relationship with the mother and encourage a healthy home life.

The Nurse-Family Partnership is based on the ground-breaking work of David Olds, professor of pediatrics, psychiatry and preventive medicine at the University of Colorado at Denver. The program is validated by almost 30 years of research and was awarded the 2010 Substance Abuse and Mental Health Services Science and Service Award by the U.S. Department of Health and Human Services. One of its first evaluations in Denver demonstrated that participating women were less likely to smoke during pregnancy, interacted more with their babies and had babies who enjoyed greater language and mental development compared to non-participants. Other studies suggest the program helps prevent child mistreatment, neglect and associated injury.³

Infant Mortality
Sudden infant death syndrome (SIDS), defined as "sudden death of an infant less than one year of age that remains unexplained after a thorough case investigation," is the nation's leading cause of death in infants without a birth defect or prematurity-related disorder. Infants are at highest risk for SIDS when they are asleep on their stomachs; the risk is greatly reduced when they are put to sleep on their backs.

The American Pediatrics Association, the National Institute of Child Health and Human Development and other organizations launched the Back to Sleep Campaign in 1994 to educate parents, caretakers and health care providers about how to reduce infants' risk of SIDS.

Since the Back to Sleep Campaign began, putting infants to sleep on their backs has increased significantly and SIDS rates have decreased more than 50 percent.⁴

Immunizations
The Colorado Children's Immunization Coalition is a statewide nonprofit that strives to improve access, delivery and demand for children's vaccines to keep Colorado healthy. CCIC educates parents about the importance and safety of vaccines through multimedia communications; offers educational opportunities and resources for health care professionals; advocates with state officials and lawmakers for improved access to immunizations; and connects a large and varied network of coalition members to share resources and knowledge.

One example of this collaboration is the Immunize for Good campaign. Created in partnership with the Colorado Immunization Program and the Vaccine Advisory Committee for Colorado, Immunize for Good is a Web-based resource for parents and providers offering up-to-date, accurate information about childhood immunizations. The website, ImmunizeforGood.com, answers questions parents have about vaccines and encourages them to vaccinate their children.

Since the campaign's launch, Immunize for Good has been cited or featured in more than 50 print articles, TV/radio interviews and online publications, in addition to hundreds of social media mentions. Between January and August 2011, ImmunizeforGood.com drew 18,516 visits from 116 countries, including 5,922 visits from 111 Colorado cities.⁵

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Promising Initiatives for Healthy Children

Uninsured
The High Plains Community Health Center, after obtaining parental consent, uses free- and reduced-price school lunch information at four Prowers County school districts to enroll uninsured children in Medicaid or the Child Health Plan Plus Program. After identifying eligible children, High Plains contacts their parents, provides application assistance and serves as a liaison between parents and the Prowers County Department of Social Services. Partly funded by the Colorado Health Foundation, the High Plains Community Health Center helped approximately 210 children obtain health insurance from April 2010 to November 2011.⁶

Poverty
The Foundation for Educational Excellence, with the assistance of the Colorado Health Foundation, Piton Foundation, Gates Foundation and other philanthropic organizations, is constructing The Promise Center. This will be a community center built on the Denver Public Schools' Dr. Evie Dennis Campus to serve far northeast Denver neighborhoods, where as many as 20 percent of children live in poverty. The Promise Center was inspired by the Harlem Children's Zone in New York City and is based on the belief that by providing services from conception to adulthood, children will grow into successful adults. This $15 million facility will house a variety of services available to children and their families, including early childhood education, after-school programming, athletics, parent education programs and financial literacy classes. A number of nonprofits and other agencies will also provide services through The Promise Center.

The Promise Center is expected to open in September 2012.⁷

Medical Home
A number of children in Larimer County's foster care system have enjoyed access to a new source of primary care since March 2010. Healthy Harbors, a pilot program funded in part by The Colorado Health Foundation, serves approximately 30 percent of Larimer County's foster care children who lack health care. This program benefits from strong partnerships among community, mental health, dental and primary care partners in Larimer County. A patient navigator helps children receive the care they need and creates a portable "Health Passport" they may use in future placements. Housed at the Fort Collins Family Medicine Residency Program/Poudre Valley Health Family Medicine Center, Healthy Harbors provided comprehensive, coordinated services for 50 foster- and kinship-care children and families in 2010.⁸

Preventive Dental Care
Cavity Free at Three (CF3), created in 2006, is an early childhood cavity prevention program for low-income mothers and their babies. This evidence-based program seeks to prevent the transmission of bacteria from mother to child through education and oral health care for children up to 3 years old. Engaging health professionals, public health practitioners and early childhood educators, CF3 increases at-risk mothers' access to cavity detection services and provides technical assistance to health care providers so they may conduct oral health screenings. In April 2010, CF3 received national recognition from the Agency for Healthcare Research and Quality's Health Care Innovations Exchange for its ability to improve care quality for these women and children and reduce oral hygiene disparities.

CF3 became a permanent part of the Colorado Area Health Education Center System in 2009. As of November 2011, the program has provided 15,000 children and families with dental services and distributed 14,000 oral health kits. CF3 trainers have conducted 62 educational presentations, reaching more than 1,200 health care providers. Ten Colorado communities have received CF3 grants totaling $1.5 million funded by the Colorado Health Foundation, Caring for Colorado Foundation, The Colorado Trust, Delta Dental of Colorado Foundation, Kaiser Permanente and Rose Community Foundation.⁹

Vigorous Exercise
The Youth Foundation (TYF) is an Eagle County organization that serves at-risk children in kindergarten through 8th grade using the evidence-based program Coordinated Approach to Child Health (CATCH). Created by the University of Texas, CATCH is a comprehensive approach that engages students in physical activity. It has been shown to increase levels of moderate to vigorous physical activity among participants. Besides offering comprehensive exercise activities, the CATCH after-school program provides nutrition education. The use of CATCH in TYF's Kidstrong program helps children reach the Centers for Disease Control and Prevention's suggested weekly amount of exercise; CATCH students participate in three to four days of after-school activities each week, providing a minimum of four hours of weekly exercise.

TYF has helped more than 1,500 youth increase their physical activity by 200 percent through the CATCH-informed Kidstrong program since 2009. The program enjoys a 94 percent student attendance rate among participants.¹⁰

Obesity
To address the high obesity rate among children in Denver metro area counties, the nutrition section of the University of Colorado at Denver (UCD) School of Medicine's Department of Pediatrics is collaborating with the area's school-based health centers and community partners to provide families with preventive solutions. Through funding in part from the Colorado Health Foundation, UCD will help reinforce the infrastructure at these facilities by providing them with more resources and information to help their patients achieve a healthier weight. UCD will also teach medical providers skills in motivational interviewing and creating and assessing healthy weight goals. UCD intends to facilitate screening and counseling that will help more than 1,900 families by the end of 2012.¹¹

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Promising Initiatives for Healthy Adolescents

Uninsured
School-based health centers (SBHCs) are clinics located in schools or on school grounds. They are designed to improve access to primary health care, reduce absenteeism and hospital visits, and improve age-appropriate screening and immunizations for children up to 18 years old. SBHCs treat vulnerable children who are often uninsured. The centers have been shown to improve academic outcomes by helping improve students' health so they can learn better. SBHCs are staffed primarily by nurses who use a multidisciplinary approach to primary care by coordinating with behavioral health specialists and oral health professionals.

During the 2009-10 academic year, 19 SBHC programs operated 45 clinic sites in schools across Colorado. Approximately 27,500 children and adolescents in Colorado were served, 31 percent of whom were uninsured.¹²

Poverty
The Piton Foundation has identified a 41 square-mile strip of land across northeast Denver and into Aurora that is home to many of the most at-risk children in the Denver metro area. This area, named the Children's Corridor, will be the subject of a robust effort to increase high school graduation rates and the proportion of children with a medical home. Modeled after the Harlem Children's Zone in New York City, the Piton Foundation is partnering with neighborhood groups, nonprofits, child-care centers, schools and other foundations to create a coordinated community effort that will help a new generation of children. Over the next 20 years, the Piton Foundation will create opportunities for healthy early child development, behavioral and emotional health, quality K-12 education and community and family support.¹³

Nutrition
Although poor nutrition is known to interfere with a child's ability to learn and can lead to lower academic achievement, Colorado's school-provided meals are often made with heavily processed, low-nutrition ingredients. To help provide the nutritious food children need to grow up healthy and be better students, LiveWell Colorado is striving to improve school meals through its Freshen-Up School Food Initiative. LiveWell Colorado plans to help tens of thousands of Colorado children access more nutritious, healthy school meals by providing healthy food training for school food service employees using the nationally recognized Cook for America Boot Camp.

The Boot Camp's curriculum includes components that emphasize scratch cooking and nutritious food that is appealing to children. By the end of the five-day event, participants are equipped with tools to help them incorporate scratch cooking into their school food programs. Furthermore, Cook for America-certified local chefs provide year-round assistance to support school food service workers as they develop healthy meals and learn new cooking techniques.

LiveWell Colorado hosted four boot camps reaching 33 school districts in 2010. Teacher surveys from the Garfield RE-2 school district in western Colorado indicate students were better behaved and more attentive after healthier school meals were implemented.¹⁴

Vigorous Exercise
The Denver Public Schools launched DPS Health Agenda 2015 in October 2010, outlining goals across areas of school health, including physical exercise, that DPS will strive to achieve by 2015. As the second-largest district in the state, DPS serves 79,423 students, 31 percent of whom are overweight or obese. The DPS strategy is designed to help high-need students be healthier so they can learn better. The program will provide physical education teachers with more support and training to promote moderate to vigorous physical activity.

DPS uses the Sports, Play and Active Recreation for Kids (SPARK) after-school physical education program, one of the most rigorously studied physical education programs in the United States. Recognized by the American Heart Association as an evidence-based program, SPARK promotes vigorous exercise and teaches movement and sports skills. SPARK has been repeatedly shown to improve students' health, fitness, enjoyment and academic achievement.¹⁵

Binge Drinking
Over the next five years, the Colorado Prevention Partnership for Success aims to reduce substance abuse among Hispanic teens in Adams, Denver, Pueblo and Weld counties. Colorado received a $2.3 million grant in 2010 from the federal Center for Substance Abuse Prevention to improve prevention services for Hispanic youth, a population increasingly at risk for substance abuse and binge drinking. CPPS will promote culturally specific, evidence-based services and policies and a social media campaign, as well as reinforce the current substance abuse prevention infrastructure to serve these teens. CPPS seeks to reduce binge drinking among Hispanic high school youth 5 percent after three years and 8 percent after five years.¹⁶

Smoking
Launched in 2000, the truth is a national anti-smoking campaign aimed at youth ages 12-17 years old. The program aims to educate them about the tobacco industry's advertising methods and provides blunt facts about the consequences of smoking. Previous research indicates the truth campaign commercials were seen by approximately three-fourths of 12-17 year-olds during its first year, and they considered the commercials interesting. A longitudinal study published in 2009 suggests that exposure to the truth's commercials lowered smoking risk 20 percent.¹⁷

Depression
Reconnecting Youth (RY) is a prevention program that engages teens 14- to 18-years-old who are at risk for dropping out of school. Such students are often in high emotional distress, exhibiting aggression, depression and suicidal behaviors. RY helps students get back on track by using a comprehensive approach that attempts to address all challenges that contribute to their academic difficulties.

RY employs a partnership among students, school administrators, parents and prevention specialists. The partnership is structured as a high school elective course to help youth reconnect to school and achieve healthy goals. RY classes are led by certified instructors and typically are offered as a regular class period. Classes teach life-skill lessons and include peer bonding activities to encourage healthy social behaviors that help diminish depressive behaviors. Outside of normal class time, RY educates faculty and staff about warning signs and indicators of depression and potential suicide by coordinating a school crisis response system. Research suggests that RY reduced most participants' depressive symptoms by at least 25 percent. RY is recognized as "exemplary" by the National Dropout Prevention Center.¹⁸

Attempted Suicide
A grass-roots community effort in Jefferson County that began in 2002 has grown into the Second Wind Fund. SWF aims to decrease teen suicide in Colorado by offering a network of local partners that provides depressed and suicidal teens with urgent help. If a teen referred by SWF does not have insurance or cannot pay for the necessary mental health treatment, SWF will cover the cost of services. Teens can attend up to 20 sessions with a therapist. Since its inception, more than 400 schools and other agencies have referred teens to SWF, and 2,900 adolescents, including 600 in 2010, have received services. Approximately 90 percent show significant improvements in suicidal behaviors after five sessions.¹⁹

Sexually Active
The Children's Aid Society's Carrera Adolescent Pregnancy Prevention Program is an evidence-based, comprehensive approach to sexual education that serves at-risk youth in Harlem, New York. Through sustained engagement, Carrera attempts to foster strong relationships between students and instructors and instill principles designed to empower students. Carrera begins delivering age-appropriate lessons to 10- and 11-year-old children and is available until high school graduation and beyond. Students receive life skills education, family life and sexuality education and sports opportunities. This program's multifaceted approach to pregnancy prevention helps children identify obstacles to their success, including teen pregnancy, and supports them as they make choices to become successful adults.

Delivered as an after-school activity or a school period, this program has been rigorously evaluated, and research demonstrates its effectiveness. In one study, females participating in Carrera over a three-year period were half as likely to have sex. Among those who did have sex, females were more than twice as likely to use a contraceptive during intercourse and were one-third as likely to become pregnant. Additionally, participants were more likely to graduate from high school and attend college.²⁰

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. Safer Choices values comprehensive, community-wide change. By engaging teachers, staff, parents, community members and students, the program attempts to foster a positive, healthy atmosphere in schools that provides teens with the support they need as they make healthy safe sex choices. This program was recently identified as a "Program that Works" by the Centers for Disease Control and Prevention and is being implemented in Colorado through Planned Parenthood of the Rocky Mountains.

An evaluation conducted in 20 high schools in California and Texas demonstrated the program was effective at increasing contraception and condom use. Sexually active teens were almost twice as likely to use some form of birth control after completing the program. Furthermore, Hispanic youth were significantly more likely to delay initiation of sexual activity compared to those not involved in the program.²¹

Teen Fertility
The Teen Outreach Program aims to prevent teen pregnancy and school dropouts by helping teens build self-esteem, life skills and create achievable goals through community service. TOP connects this volunteer work to classroom discussions on a wide range of issues, from family conflict to sexual development. The combination of community service and facilitated discussion encourages personal development and healthy behaviors, including making safer sex choices.

Females who participate in TOP have been shown to have a 53 percent lower risk of becoming pregnant. Denver Health is implementing TOP in Boys and Girls Clubs of Metro Denver.²²

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Promising Initiatives for Healthy Adults

Uninsured
The Denver Health Foundation's Health Access Express Enrollment Van is a new approach designed to help eligible Denver residents enroll in public health insurance programs such as Medicaid and the Child Health Plan Plus (CHP+). The enrollment van is the first of its kind in Colorado and attempts to make enrollment easier by bringing it to neighborhoods. Funded by the Colorado Health Foundation, this colorful van is equipped with three work stations for bilingual staff to conduct enrollment screenings. A play area is available for children while their parents fill out forms. The enrollment van frequents school-based health centers, Head Start programs, grocery stores, low-income housing, food banks and other venues that serve uninsured individuals who are likely to qualify for Medicaid or CHP+.

Between March 2009 and February 2011, the Health Access Express completed 1,521 applications for 4,436 beneficiaries.²³

Medical Home
The University of Colorado Foundation's Measuring Change in Communities Building Medical Homes initiative seeks to foster collaboration between medical providers to facilitate the creation of new medical homes. In partnership with the Colorado Department of Public Health and Environment, the goal of the program is to develop and implement best practices for building medical homes in communities. This pilot program will assign evaluators to assess collaboration in Summit County and three Denver metro area counties and provide them with technical assistance and evidence-based tools to help establish effective medical homes. The program aims to help more than 8,000 individuals access a medical home.²⁴

Nutrition
Founded in 1994, Cooking Matters Colorado provides low-income Coloradans with nutrition education classes. CMC uses professional chefs and nutritionist volunteers to lead interactive cooking classes that instruct children and adults on how to make the most value-added, nutritious meals within a realistic budget. Each week, participants learn how to create a nutritious meal and take food and kitchen tools home so they can recreate their lessons. These incentives encourage participation and promote healthy choices at home.

CMC coordinated 170 courses that served 2,113 families in Colorado in 2010. Course evaluations indicated approximately 65 percent of participants eat more fruits and vegetables, 71 percent eat more whole grains, and 89 percent have improved cooking skills after taking the CMC curriculum.²⁵

Exercise
Denver B-cycle is the largest bike-sharing program in the country. Sponsors include LiveWell Colorado, Kaiser Permanente, Rose Medical Center, and other health and civic organizations and corporations. This program allows people to rent a bike for short trips around town, providing environmental benefits by reducing car usage as well as health benefits by promoting daily exercise. Denver B-cycle has 510 bikes across 51 stations distributed at locations across central Denver. Future expansions are planned.

From March to August 2010, riders made almost 120,000 trips using Denver B-cycles. They rode more than 240,000 miles and spent 31,747 hours in physical activity.²⁶

Obesity
The Colorado Department of Public Health and Environment's Colorado Physical Activity and Nutrition Program strives to prevent obesity and its associated diseases through broad-based initiatives that promote healthy exercise and eating. The COPAN has more than 450 public and private partners, including government, public health and transportation officials, and local planners. The coalition designs, implements and evaluates state-level obesity initiatives.

The COPAN's Active Community Environment Task Force (ACE) aims to increase physical activity in Coloradans' daily routines by evaluating and improving community infrastructure to create exercise-conducive neighborhoods. ACE activities also include educational workshops and an annual active living conference. The LiveWell Wheat Ridge ACE in 2010 helped establish a new recreation center that offers comprehensive exercise activities such as yoga, tai chi, swimming and dance.²⁷

Current Smokers
The Colorado QuitLine provides a comprehensive approach to address tobacco addiction. Colorado QuitLine offers a variety of free services to Colorado residents 15 and older who want to stop using tobacco, including research-based information and support from a team of coaches. Colorado QuitLine members can call a toll-free number (1-800-Quit-Now) for help in creating personal quit plans and getting tips to overcome common obstacles such as stress, tobacco cravings, irritability and weight gain. Often, Colorado QuitLine's successful clients become coaches. In addition to online resources and coaching services, Colorado residents 18 and up can receive free nicotine patches.

The Colorado QuitLine serves approximately 3,800 people each month. Approximately 44 percent of clients are able to quit smoking while they are enrolled. This service and other smoking prevention and cessation programs are supported through excise taxes on tobacco due to the voter-approved Amendment 35.²⁸

Binge Drinking
Healthy Workplace, a program funded by the National Institutes of Health, aims to prevent at-risk employees from abusing alcohol or drugs. With components that target binge drinking, illegal drug use, prescription drug abuse and healthy living, Healthy Workplace attempts to educate participants about the consequences of substance use and provides them with tools to prevent addiction. Healthy Workplace classes are delivered in ways designed to help minimize stigmas associated with substance abuse recovery.

Healthy Workplace has been rigorously evaluated and is included in the Substance Abuse and Mental Health Services Administration registry of evidence-based programs. In one study, Healthy Workplace participants achieved a 47 percent reduction in the number of drinks consumed in the past 30 days, as well as a 67 percent reduction in the number of days of heavy drinking during the same period. Other studies have shown similar results.²⁹

Poor Mental Health
Metro Crisis Services provides intervention, assessments, psychiatric urgent care, stabilization and support for people experiencing a mental health crisis. Individuals in crisis are often treated in jail or the emergency room – neither of which may have the appropriate resources to provide the best care. MCS stabilizes individuals in mental health crisis and directs them to sources of high quality and cost-effective care. Staffed by trained behavioral health professionals, peer support and family outreach specialists, this free, 24/7 crisis line (1-888-885-1222) is available to Denver metro area residents. MCS receives an average of 1,000 calls each month.³⁰

Diabetes
Diabetes is a significant problem in the Hispanic community. Nationally, about one in 10 Hispanics over 20 years old has the disease. Por Tu Familia, meaning "For Your Family," is a nationwide program implemented by the American Diabetes Association in Hispanic communities to offer culturally competent outreach. In Colorado, Por Tu Familia strives to foster a trusting relationship between health education providers and families to promote healthy, cross-generational change. A range of educational opportunities and classes targets different elements of diabetes and its associated risks, including peripheral neuropathy, eye disease and heart disease. Por Tu Familia also emphasizes the importance of physical exercise and diet, offering classes on Latin dance and healthy Latin cooking.

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. In 2009, registered dieticians, nurses, nutritionists, certified diabetes educators and other health care professionals provided Por Tu Familia classes in 26 Colorado counties at 41 medical clinics. More than 4,000 people attended a sponsored Diabetes Expo in 2009.³¹

High Blood Pressure
Wellness Outreach at Work provides employees with broad health risk reduction benefits, including cardiovascular and cancer risk screenings as well as personalized follow-up health coaching to mitigate conditions such as hypertension. Employees can make health goals together with their wellness coach and participate in follow-up meetings to assess their progress, all in the convenience of their workplace.

WOW has served 6,500 individuals in 36 worksites since 1976 and is recognized by the Substance Abuse and Mental Health Services Administration as an evidence-based practice. Research funded by the National Institutes of Health has demonstrated its effectiveness. In a study of more than 500 employees, WOW decreased the percentage of individuals with high blood pressure by almost 25 percent and increased the number of people with healthy cholesterol levels almost 15 times. In addition, almost 20 percent of participants lost 10 or more pounds.³²

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Promising Initiatives for Healthy Aging

Medical Home
Total Longterm Care is one of the original Programs of All Inclusive Care for the Elderly, a comprehensive long-term care model that enables seniors to maintain their independence by living at home for as long as they can. PACE is based on the belief that seniors who need frequent assistance can achieve a greater quality of life if they are served in the community or at home. PACE provides integrated acute- and long-term care services, primary and specialty care, case management, and mental health and substance abuse services.

A 2011 study suggested that individuals enrolled in PACE were four times less likely to be hospitalized compared to a control group. Furthermore, savings accrue by transitioning seniors from high-cost nursing homes or hospitals back into their homes. TLC has recently opened a PACE location in Pueblo and serves 200 seniors there.³³

Immunizations
Every October, the Hillside Community Center in Colorado Springs hosts the Hillside Senior Health Fair, which offers a variety of service booths addressing senior health concerns. Screenings are available to test for common senior ailments, including diabetes, cardiovascular disease, and poor hearing and memory. Immunizations such as flu shots are offered. Many of these services are free or low-cost for Medicare enrollees. People who are uninsured or low-income can receive services as well. In 2011, 152 seniors attended the Hillside Senior Health Fair.³⁴

Exercise
Community Heart Health Actions for Senior Latinos at Risk (CHARLAR), funded in part by the state Office of Health Disparities and the Colorado Health Foundation, strives to help Latinos ages 45 and older achieve healthier lifestyles and lower their cardiovascular disease and diabetes risk. CHARLAR is delivered over 12 weekly two-and-a-half hour sessions in certain northwest Denver locations by promotoras – bilingual outreach workers from within the Latino community. CHARLAR, which means "to chat" in Spanish, uses ongoing dialogue to foster a supportive community among participants as they strive to live healthier lives. The CHARLAR project employs an evidence-based curriculum called Pasos Adelante, which has been developed and evaluated by the University of Arizona. Research suggests that Pasos Adelante increased walking and total exercise time among participants by an average of 70 minutes a week. Half of participants increased their walking to two or more hours a week.³⁵

Poor Physical Health
Arthritis is the most common cause of disability in the United States and affects more than 50 million people nationally. In partnership with the Colorado Health Foundation, the Rocky Mountain Chapter of the Arthritis Foundation (AF) offers the Life Improvement Series Program to help Coloradans with arthritis participate in evidence-based exercise and self-help classes that may help minimize their discomfort and lead to an enhanced quality of life. Individuals with other chronic conditions may participate too.

The Life Improvement Series is currently available in 84 locations across Colorado, serving 2,394 individuals between January and June 2011. Participants of AF's exercise programs have experienced significant improvements in range of motion and muscle strength, and reported fewer physician visits and an enhanced quality of life. Similarly, a study completed as a part of a Life Improvement Series program expansion found 86 percent of participants experienced an improvement in pain management after they began participating, and 83 percent reported improved ability to perform daily activities.³⁶

Poor Mental Health
Seniors with mental health needs are often unable to access mental health providers due to mobility constraints. In Colorado Springs, Silver Key Services, the area's largest provider of non-medical essential services for homebound seniors, and the University of Colorado's Aging Center have teamed to create the At-Home Program to serve frail, homebound seniors who would otherwise be unable to access mental health services. Clinicians visit seniors identified as at-risk for mental illness at their homes for up to 20 sessions at no cost. If additional in-home services are necessary, payment may be made on a low-fee, sliding scale to allow low-income seniors access to the care they need. Many clients choose to continue well past 20 visits. The At-Home Program has provided more than 300 seniors with counseling and assessment services in the comfort and privacy of their homes since 2003.³⁷

Limited Activity
SilverSneakers Fitness Program provides seniors with exercise opportunities to help them maintain their independence and physical ability. Developed in 1992, SilverSneakers is tailored to suit seniors' health and physical needs. This program offers a variety of classes to improve balance, flexibility and endurance, and provides social opportunities and support that encourage prolonged participation.

A 2008 Centers for Disease Control and Prevention-funded study found individuals who participated in SilverSneakers experienced fewer hospital admissions and saved an average of $500 in health care costs. SilverSneakers is offered in more than 40 locations across Colorado, is free at YMCAs for its members and is an included benefit in many Medicare supplement plans.³⁸

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Footnotes:

1. Klima, C, et al., "Introduction of CenteringPregnancy in a public health clinic," Journal of Midwifery and Maternal Health, 2009.
   
   Robertson, R, et al., "Comparison of CenteringPregnancy to traditional care in Hispanic mothers," Maternal and Child Health Journal, 2009.
   
   
2. The Rocky Mountain Health Plans Foundation.
   
   Gadomski, A, et al., "Effectiveness of a combined prenatal and postnatal smoking cessation program," Maternal and Child Health Journal, February 2011.
   
   Baby & Me - Tobacco Free.
   
   
3. Nurse-Family Partnership.
   
   U.S. Department of Health and Human Services.
   
   Olds, D, "The nurse–family partnership: An evidence-based preventive intervention," Infant Mental Health Journal, 2006.
   
   MacMillan, H, et al., "Interventions to prevent child maltreatment and associated impairment," Lancet, January 2009.
   
   
4. PubMed Health, "Sudden Infant Death Syndrome," August 2011.
   
   American SIDS Institute.
   
   National Institute of Child Health and Human Development, August 2011.
   
   
5. Colorado Children's Immunization Coalition.
6. Reyna Perez, School Outreach Worker at High Plains Community Health Center, November 16, 2011.
7. The Colorado Health Foundation.
8. Barnett, D, and D Sullivan, "Healthy Harbors: A 'medical home' for kids in frequent transition," Colorado Academy of Family Physicians, 2010.
9. Cavity Free at Three.
   
   The Colorado Trust.
   
   
10. Kelder, S, et al., "The CATCH Kids Club: A pilot after-school study for improving elementary students' nutrition and physical activity," Public Health Nutrition, April 2004.
11. The Colorado Health Foundation.
12. Colorado Association for School-based Health Care.
    
    Walker, S., and S. Kerns, "Impact of school-based health center use on academic outcomes," Journal of Adolescent Health, March 2010.
    
    2009-10 Colorado Health Institute/Colorado Association for School-based Health Care survey of Colorado school-based health centers.
    
    
13. The Piton Foundation.
14. Florence, M., et al., "Diet quality and academic performance," Journal of School Health, April 2008.
    
    LiveWell Colorado.
    
    
15. McKenzi, T., et al., "Beyond the stucco tower: Design, development and dissemination of the SPARK physical education programs," Quest, American Academy of Kinesiology and Physical Education, 2009.
16. Colorado Prevention Partnership for Success.
17. Farrelly, M, et al., "Getting to the truth: Evaluating national tobacco countermarketing campaigns," American Journal of Public Health, June 2002.
    
    Farrelly, M, et al., "The influence of the national truth campaign on smoking initiation," American Journal of Preventive Medicine, May 2009.
    
    
18. Substance Abuse and Mental Health Services.
19. Second Wind Fund.
20. Philliber, S, et al., "Preventing pregnancy and improving health care access among teenagers: An evaluation of the Children's Aid Society-Carrera Program," Perspectives on Sexual and Reproductive Health, September/October 2002.
    
    Philliber Research Associates, "More than a decade of research on the Children's Aid Society Carrera Adolescent Pregnancy Prevention Program: 1999-2010."
    
    
21. The National Campaign to Prevent Teen and Unplanned Pregnancy, What Works 2010: Curriculum-Based Programs That Help Prevent Teen Pregnancy, 2010.
    
    Coyle, K, et al., "Safer choices: Reducing teen pregnancy, HIV and STDs." Public Health Reports, 2001.
    
    
22. Wyman's Teen Outreach Program.
23. Denver Health.
24. The Colorado Health Foundation.
25. Share Our Strength's Cooking Matters 2010 Annual Review.
26. LiveWell Colorado.
    
    The Denver Post, August 29, 2011.
    
    Denver B-Cycle.
    
    
27. Colorado Department of Public Health and Environment, Colorado Physical Activity and Nutrition Program, Active Community Environments.
    
    LiveWell Wheat Ridge.
    
    
28. Colorado Department of Public Health and Environment, Colorado QuitLine.
29. Substance Abuse and Mental Health Services Administration, National Registry of Evidence-based Programs and Practices.
30. Metro Crisis Services.
31. National Institute of Diabetes and Digestive and Kidney Disorders, "The Diabetes Epidemic among Hispanics/Latinos," 2009.
    
    American Diabetes Association, Featured Projects.
    
    
32. Substance Abuse and Mental Health Services, National Registry of Evidence-Based Programs and Practices, 2008.
33. Meret-Hanke, L, "Effects of the Program of All-Inclusive Care for the Elderly on hospital use." The Gerontologist, 2011.
    
    Total Longterm Care.
    
    
34. Hillside Community Center.
35. The Colorado Health Foundation.
    
    Staten, L, et al., "Pasos Adelante: The effectiveness of a community-based chronic disease prevention program," Preventing Chronic Disease, 2005.
    
    
36. Centers for Disease Control and Prevention.
    
    The Arthritis Foundation.
    
    
37. Silver Key Services.
    
    University of Colorado Aging Center.
    
    
38. SilverSneakers Fitness Program.
    
    Nguyen, H, et al., "Managed-Medicare health club benefit and reduced health care costs among older adults," Preventing Chronic Disease, 2008.