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 which hold promise 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.
Promising Initiatives for Healthy Beginnings
B4 Babies and Beyond
B4 Babies and Beyond provides a single unified
entry point into prenatal care services for low-income women in
Mesa County. B4 Babies has successfully reduced the number of
babies born at a low birth weight. It was recognized in 1997 by
the U.S. Department of Health and Human Services as a “Model
that Works.” The program has proven so successful that 100
percent of physicians and certified nurse midwives who deliver
babies in Mesa County and 98 percent of the pediatric and family
practice physicians participate in the program.
Prenatal Plus Program
The Colorado Department of Public Health and
Environment sponsors several programs that target women who are
at-risk for delivering a low birth weight baby. The Prenatal Plus
Program, funded through Medicaid, counsels pregnant women on strategies
for quitting smoking. Fifty-one percent of the pregnant women
who enter the program quit smoking, which has contributed to reducing
the incidence of low birth weight from 14 to 9 percent.
The Nurse-Family Partnership
The Nurse-Family Partnership (NFP), a 20-year-old
Denver-based program, provides comprehensive
prenatal care to low-income, first-time expectant
parents. A nurse visits the home regularly
to encourage a nurturing family environment throughout the pregnancy,
as well as the first years of the infant’s
life. The result: Participants in Boulder
reduced the number of low birth weights they
report by 8 percent.
The Aurora/Arapahoe Healthy Start Initiative
The Aurora/Arapahoe Healthy Start initiative
targets families in six zip codes with high infant mortality rates.
This initiatives provides participants access to comprehensive
prenatal, postpartum, infant and child care as needed. The goal
is to reduce infant mortality through a community-based, targeted
outreach and service model that improves access to services for
minority families with high rates of poverty.
The Colorado Children’s Immunization Coalition
The Colorado Children’s Immunization Coalition (CCIC) has
achieved significant successes since it was
established in 1995 through funding from The Colorado Trust. Among
them: Administering a seven-year, $3 million immunization improvement
project that reached 10 counties and 75 clinics. CCIC worked with
other organizations to expand the state childhood immunization registry,
and lobbied state officials to get the first-ever allocation of
state funding – $250,000 in 2005 and $368,000 in 2006 – to
expand the Colorado Immunization Information System.
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Promising Initiatives for Healthy Children
The 2010 All Kids Covered
The 2010 All Kids Covered initiative is a two-year-old
collaborative effort among a variety of organizations in the health
care community. Led by the Colorado Coalition for the Medically
Underserved, the Colorado Children’s Campaign and Colorado
Covering Kids and Families, members work together to craft and
promote legislation to expand access to meaningful health insurance
coverage for children in Colorado. In its first year, the initiative
was instrumental in passing two important pieces of legislation.
The first mandates that state government collect data on the number
of publicly insured children who have a “medical home,” that
is, a primary health care provider. The second provides for “presumptive
eligibility,” a policy that enrolls eligible children in
public health care programs so they may receive vital and timely
care while their applications are processed and verified.
The Colorado Children’s Campaign
The Colorado Children’s Campaign gives voice to 1.2 million
Colorado children. Although the Campaign advocates
for the needs of all children, a particular
focus is on those living in low-income families.
With little disposable income, these families
struggle to gain access to adequate K – 12
education and basic health care services for
their children. The Colorado Children’s
Campaign has a 21-year history in Colorado
and during this time has promoted the passage
of such programs as Child Health Plan Plus
(CHP+) and a range of public health initiatives designed to promote
the health and well-being of the state’s
children.
The Colorado Children’s Healthcare Access Program
The Colorado Children’s Healthcare Access Program (CCHAP)
seeks to ensure that every child in Colorado has a high quality
medical home. CCHAP encourages and enables pediatricians and family
physicians in private practice to devote 10 – 20 percent of
their practices to children enrolled in Medicaid or Child Health
Plan Plus (CHP+). To date, CCHAP has expanded to 28 practices in
34 pediatric locations around the Denver Metro Area. CCHAP is also
establishing a demonstration program with the Department of Health
Care Policy and Financing to provide higher reimbursement and incentives
to physicians that provide comprehensive care to publicly-insured
children. Three years ago, only 20 percent of private pediatric
practices in the Denver area accepted Medicaid or CHP+ children;
today the number has increased to almost 50 percent. CCHAP envisions
expanding to the rest of the state over the next two years.
Cavity Free at Three
Cavity Free at Three is a collaborative effort
of The Colorado Health Foundation, Caring for Colorado Foundation,
Delta Dental Foundation and Rose Community Foundation. This project
is designed to strengthen the safety net’s capacity to provide
preventive services to high-risk, high-need pregnant women and
their babies, up to age 3. The goal: to change oral health delivery
systems so that dental disease can be completely prevented in
young children in Colorado. Caring for Colorado began a five-year
plan in 2002 dedicating $5 million to promote oral health in Colorado.
A primary target of the Oral Health Improvement Program is low-income
children. Through collaborations between oral health and primary
health care providers, the program seeks to increase preventive
education and oral health services to both children and new mothers
who encounter various barriers to obtaining needed care.
Stapleton’s Healthy Living and Healthy Neighborhoods
Stapleton has been transformed from Denver’s former airport
into a model community for healthy living,
with an urban design plan that encourages children
and adults to engage in regular physical activity.
Adopting programs such as the Passport to Healthy
Living and the Healthy Neighborhood’s
Initiative, Stapleton designers have teamed
up with the University of Colorado at Denver
and Health Sciences Center to provide programs
that educate residents on how to maintain more
healthy and active lifestyles. The Transport
Management Association works with the Stapleton
community to provide alternatives to car transportation
through a shuttle service and improved bicycle paths throughout
the community. Bike, Walk, Roll promotes non-car trips to school
where children are treated to breakfast and given further information
about safety while riding a bicycle.
The Colorado Physical Activity and Nutrition Program
The Colorado Physical Activity and Nutrition
Program (COPAN) is a broad-based collaborative effort to promote
education about healthy living choices in schools. COPAN’s
Nutrition State Plan 2010 seeks to raise awareness of parents,
childcare providers, preschool educators and other community agencies
with initiatives designed to create supportive environments that
promote physical activity and good nutrition.
LiveWell Colorado
LiveWell Colorado, through efforts partially
sponsored by The Colorado Health Foundation,
dedicates millions of dollars to reducing
obesity in the state. Grant recipients encourage healthy living
through policies, programs and environmental changes that often
focus on school and community settings.
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Promising Initiatives for Healthy Adolescents
Rocky Mountain Youth Clinics
Rocky Mountain Youth Clinics (RMYC) is a nonprofit
organization that provides access to high quality
health care services for children and adolescents in the Denver
metropolitan area. RMYC serves youth regardless of insurance coverage
or their family’s
ability to pay. This unique program model seeks
to provide care in those places where adolescents live and spend
their time, such as schools, youth centers, residential facilities
and homeless shelters. RMYC has three primary clinics, two mobile
units and more than 20 smaller off-site clinics. In 2007, RMYC expanded
its efforts to provide health and dental care to a number of rural
Colorado communities.
School-Based Health Centers
An increasing number of programs serving low-income
adolescents have been launched in the past 10 years. In Prowers
County, 19 percent of families live below the federal poverty
level. The county has been designated both as a medically underserved
area and a health profession shortage area. In August 2007, school
officials announced that a school-based health center (SBHC) will
be established at Lamar High School to meet the physical and emotional
health care needs of students. As of January 2007, Colorado was
home to 34 SBHCs and one mobile van serving students, 60 percent
of whom come from low-income—and likely uninsured—families.
The Keystone Center
Over the last three years, The Keystone Center
in Colorado and the National Consortium for Specialized Secondary
Schools of Mathematics, Science and Technology (NCSSSMST) has
conducted three successful Keystone Center Youth Policy Summit
programs. Each year, 40 high school students from 10 NCSSSMST
schools across the nation are invited to Colorado to participate
in the Youth Policy Summit. In 2006, in preparation for the summit,
students conducted an independent research project focused on
childhood and adolescent nutrition. At the Summit, students meet
to share their results with food, nutrition and medical experts
from prominent nonprofits, corporations and government agencies.
A final report produced by the students includes recommendations
for school administrators and state policymakers. This unique
approach challenged teen participants to think about the best
ways of delivering effective health messages to their peers.
Colorado Children’s Campaign
A recent report from the Colorado Children’s Campaign notes
that Colorado does not require physical education teachers to be
certified nor are statewide data available on how many Colorado
schools offer physical education programs. The report notes that “schools
have felt pressure to focus on academic accountability, which has
led to the elimination of ‘nonessential’ areas of study
including nutrition and physical education even though evidence
suggests that the cognitive benefits of physical activity during
the school day compensates for time not spent on other academic
areas.” Citing a parent survey that indicates strong support
for physical education requirements in schools, the report recommends
that the state collect information on physical education programs
in Colorado schools.
Colorado Connections for Healthy Schools
Colorado Connections for Healthy Schools (CCHS)
is a coalition that includes the Colorado Department of Education
and the Colorado Department of Public Health and Environment’s
school-aged children. CCHS has developed a Healthy Kids Colorado
Survey (HKCS) administered to high school students that focuses
on physical activity as it is a gateway to other health-related
issues such as poor nutrition, overweight, obesity and diabetes.
Based on findings from the 2005 – 06 survey, CCHS has developed
a comprehensive curriculum for schools that includes physical
education and nutrition classes.
Make a Difference: Talk to Your Child about Alcohol
Make a Difference: Talk to Your Child about
Alcohol, a program initiated by former Colorado
First Lady Frances Owens, targets parents
and guardians of young adolescents, ages 10 – 14.
Research shows that it is in these pre-teen
and early teen years that children begin
experimenting with alcohol. The program is designed to educate
adults on how to initiate a conversation with their children about
alcohol use, to prevent later abuse. Studies indicate that parents
can have a significant influence over their children’s
behavior. This initiative builds on a home-based
effort to promote healthy choices.
Tobacco Prevention
Colorado is one of three states that funds
a tobacco prevention program reflecting the
Centers for Disease Control and Prevention (CDC) recommendations
on anti-smoking campaigns. Funding for this program comes from
the state’s tobacco
tax. Colorado spends $1.31 billion on smoking-caused
health costs, and $25.5 million on smoking-prevention programs.
Southwest Open School
Southwest Open School (SWOS), an alternative
high school in Cortez, enrolls approximately 150 – 180 students,
most of them from low-income families. Many of these teens face
additional challenges such as homelessness, school and social
failure, chemical dependency, physical, emotional and sexual abuse,
and pregnancy. To address these problems, the school established
an on-site clinic in partnership with other community providers
including the Montezuma County Health Department, which provides
immunizations and dental clinics at the school twice a year. In
addition, the Southwest Mental Health Center and the Ute Mountain
Tribe provide counselors at the school to help students with serious
mental health issues.
Colorado Suicide Prevention and Intervention Plan
The Colorado Trust has provided grants to 10
communities throughout the state to invest in suicide prevention,
and as of August, 2007, the Trust announced it will continue to
fund these programs, as well as two additional ones. This funding
initiative has reached into 31 counties, raising awareness and
reducing the stigma of suicide. The Trust awarded $75,000 to Mental
Health America Corporation, the state’s most comprehensive
suicide prevention and education program, to oversee the Colorado
Suicide Prevention and Intervention Plan. Over a seven year period
(2002 – 2009) the Trust has dedicated $4.9 million to the
cause of reducing suicide in the state.
The Colorado Organization on Adolescent Pregnancy, Parenting
and Prevention
The Colorado Organization on Adolescent Pregnancy,
Parenting and Prevention (COAPPP) connects
communities to help them work together to prevent teen pregnancy
and STDs, while raising awareness about teen health issues and promoting
teen parents’ well-being.
COAPPP seeks to identify the specific cultural
contexts unique to each community, and target
its message to best reach diverse populations, using succinct and
up-to-date data to present the most accurate picture possible to
the public.
Sex Education (HB 1292)
In the 2007 legislative session, the Colorado
General Assembly passed HB 1292 requiring
that a comprehensive, science-based sex education
program be taught in Colorado school districts
that offer sex education. Presenting medical and scientific information,
the curriculum will discuss abstinence as the only 100 percent-effective
means of preventing pregnancy and STDs, and
will also discuss the importance of using contraceptives if sexually
active. Preceding the law, Poudre School District developed a
10-lesson, comprehensive approach to sex education. The curriculum
provides students with information on healthy relationships, condom
use, other forms of contraception and the risks associated with
sexually transmitted diseases.
The Colorado Adolescent Maternity Program
The Colorado Adolescent Maternity Program (CAMP)
is one of the oldest programs in the United States focused on
teen pregnancy. CAMP is a source of prenatal care, delivery and
postpartum care. The program views its participants as “resources
to be developed and not as problems to be managed.” Its
unique Little Sisters and Daughters Program involves the 12- to
14- year-old siblings of the teen mothers participating in CAMP.
These younger teens meet with mentors who establish trust so that
experiences can be shared, while also engaging them in discussions
about future goals, including pregnancy prevention. The goals
of CAMP are to provide comprehensive prenatal care, decrease high-school
drop out rates, and to prevent abuse and neglect of at-risk siblings
and daughters who are at increased risk of teen pregnancy.
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Promising Initiatives for Healthy
Adults
Pueblo StepUp
Pueblo StepUp is a high value limited benefit
health care coverage initiative designed to cover Pueblo’s
working uninsured. The community pursued this initiative because
the city and county consistently have had the highest insurance
premiums in the state for several years. Pueblo’s coverage
initiative will be financed through contributions from employers,
employees and the community.
The Marillac Clinic
The Marillac Clinic serves Mesa County’s low-income and uninsured
residents. The clinic is a fully integrated and comprehensive primary
care clinic offering mental health, social, dental and physical
primary care to both uninsured adults and children. Prevention and
early intervention are at the foundation of Marillac Clinic services,
where no-cost labs and sliding fee x-rays are performed at the St.
Mary’s Hospital, on whose campus Marillac is located. No one
is denied care at the clinic, although patients are expected to
pay for some portion of their visit using a sliding fee schedule
based on family income.
LiveWell Colorado
LiveWell Colorado is a collaborative effort
by The Colorado Health Foundation, Kaiser Permanente and the Colorado
Department of Public Health and Environment. The initiative is
designed to reduce overweight and obesity rates and related chronic
diseases by engaging with communities to promote healthy eating
and active living and programs targeted at environmental changes.
Colorado on the Move
Colorado on the Move is the founding affiliate
of America on the Move, a national initiative to improve health
by increasing physical activity. State affiliates work directly
in the schools, work sites and at the community level. The goal
of Colorado on the Move is to decrease consumption by 100 calories
a day while ensuring that children and adults walk at least 2,000
steps each day. Participants wear pedometers to monitor their
steps.
The Metro Denver Health and Wellness Commission
The Metro Denver Health and Wellness Commission
recently issued a report that highlights both the health and economic
costs of adult obesity. A broad coalition of 80 employers and
community leaders has come together to promote policies and programs
that support “a culture of healthy eating and active living.” Chaired
by Lt. Gov. Barbara O’Brien, the Commission aims to reverse
the negative trend in adult obesity by 2012 and increase the percentage
of healthy-weight residents by 2017. To monitor progress, the
Commission has selected eight indicators, seven of which are included
in this Report Card, by which it compares the Metro Denver area
to 25 similarly-sized metropolitan areas with which it competes
in the economic development arena.
The Colorado Clean Indoor Act
The Colorado Clean Indoor Act was enacted in
2006 to protect the public from involuntary exposure to secondhand
smoke. Amendments were recently passed in 2007 to ban smoking
in assisted-living facilities and casinos. Colorado was among
the first 13 states to enact such far-reaching legislation.
The Student Alcohol Management Foundation
The Student Alcohol Management (SAM) Foundation
seeks to educate college students and their parents about the
risks of alcohol consumption and poisoning. The Foundation offers
financial assistance to those colleges and universities that do
not currently have an alcohol awareness program. The SAM Foundation
was established after the alcohol-poisoning death of a student
at Colorado State University in 2004.
Advancing Colorado’s Mental Health Care
Advancing Colorado’s Mental Health Care is a collaborative
effort of The Colorado Health Foundation, Caring
for Colorado Foundation, The Colorado Trust
and the Denver Foundation. This five-year initiative aims to improve
the mental health status and quality of life for children, youth
and adults with severe mental illnesses by restructuring the delivery
of mental health services at the community level. Six Colorado communities
were selected to receive support for their efforts at integrating
mental health services.
The Center for African American Health
The Center for African American Health is focused
on improving the health and well-being of African-Americans in
the Metro Denver area. The Center seeks to reduce significant
health disparities, including diabetes and high blood pressure,
which disproportionately affect African-Americans. Community-based
health education, participatory research, and outreach programs
that promote active and healthy lifestyles comprise the heart
of the center’s activities.
Colorado Heart Healthy, Stroke Free: Reaching the Future
Colorado Heart Healthy, Stroke Free: Reaching
the Future 2005 – 2010 is a state initiative of the Colorado
Department of Public Health and Environment developed with input
from community agencies and public health experts. Findings from
the Behavior Risk Factor Surveillance System survey among Colorado
adults revealed that less than one-third were able to identify
signs of a heart attack or stroke. An important component of the
Colorado Heart Healthy, Stroke Free strategy is informational
campaigns that deliver appropriate and understandable messages
to the public about identifying symptoms. The program also encourages
hospitals to adopt recognized standards for heart disease and
stroke treatment. An ongoing assessment of the program will identify
best practices and suggest appropriate changes.
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Promising Initiatives for Healthy
Aging
Healthy Aging Initiative
The Colorado Trust recently launched a four-year,
$6.5 million Healthy Aging initiative. This
statewide initiative has provided grants
to 20 community-based organizations to strengthen and expand access
to services for older adults, including training for caregivers
of older adults, and wellness programs tailored to older adults.
The Colorado Influenza and Pneumococcal Alert Coalition
The Colorado Influenza and Pneumococcal Alert
Coalition (CIPAC) works to raise public awareness of the importance
of older adults receiving vaccinations. In 2002, CIPAC was awarded
the Excellence in Immunization Award by the National Partners
for Immunization (NPI) for its outstanding community outreach
program. CIPAC has developed commercials and collects and disseminates
pertinent data to health care providers.
The Consortium for Older Adult Wellness
The Consortium for Older Adult Wellness is
the only known organization in Colorado that trains professionals
who work with older adults in model best-practice chronic disease
prevention programs. The consortium offers safe, evidence-based
best practice models and programming in the areas of physical
activity, nutrition and fall prevention. These classes are for
implementation in recreation centers, senior centers, nursing
homes, assisted living centers, independent living centers, outpatient
clinics, congregate meal sites, churches or anywhere older adults
gather. COAW also provides technical assistance and consulting
to organizations wishing to establish older adult wellness programs
or plan health education strategies targeting older adults.
Chronic Disease Self-Management Program
The Colorado Department for Public Health and
Environment is launching Stanford University’s Chronic Disease
Self-Management Program (CDSMP) for older
adults who lack private health plans. An internationally accepted
best practice in disease management, the program helps participants
set goals, make decisions and find the resources and support they
need to make informed decisions about exercise, healthy eating,
intimacy and personal relationships and positive communication
with friends, family and caregivers. The program also provides
information on medication management and best ways to participate
in their medical treatment decisions. At the end of the program,
each participant leaves with an action plan for self-management.
Senior Reach
Senior Reach serves adults 60 and older in
Jefferson, Gilpin, Clear Creek, Boulder and
Broomfield counties. It is a joint project
of the federal Substance Abuse and Mental Health Services Administration,
Jefferson Center for Mental Health, the Mental Health Centers
serving Boulder and Broomfield counties and
the Seniors Resource Center. The program has provided better and
less-fragmented services to older adults in community, and helped
more people to understand the special needs of seniors. It has
instilled a willingness among those assisting older adults to
be the “eyes and ears” in
the community, and it has improved intra-agency
collaboration. Senior Reach was recently awarded the 2007 Golden
Light Bulb Award for best practices in the clinical arena by the
Colorado Behavioral Healthcare Council.
The Colorado Physical Activity and Nutrition Program
The Colorado Physical Activity and Nutrition
Program (COPAN) awarded eight grants to organizations throughout
Colorado that promote physical activity for older adults. Several
grant recipients have used the funds to train staff and to purchase
age-appropriate equipment. The town of Buena Vista and the Upper
Arkansas Area Agency on Aging have used the funding to launch
the Arthritis Foundation Self-Help Program, a six-week course
that has been demonstrated to reduce arthritis pain by 20 percent
and physician visits by 40 percent.
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