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Public Health Futures: Considerations for a New Framework for Local Public Health in Ohio

This report proposes a model for Ohio’s local governmental public health system. The model includes a mechanism for governance and sustainable financing that considers cross-jurisdictional sharing and/or regionalization, enhances quality, and assures value. The project, which is the result of a public health project guided by a steering committee of health commissioners, explored cross-jurisdictional sharing […]

Public Health Futures: Considerations for a New Framework for Local Public Health in Ohio

May 17, 2013

This report proposes a model for Ohio’s local governmental public health system. The model includes a mechanism for governance and sustainable financing that considers cross-jurisdictional sharing and/or regionalization, enhances quality, and assures value. The project, which is the result of a public health project guided by a steering committee of health commissioners, explored cross-jurisdictional sharing of services and consolidation as potential strategies for improving public health efficiency and quality.

Available online (pdf): http://www.aohc.net/aws/AOHC/asset_manager/get_file/93404/phf_fullreport_final_11302012_mm.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: The report provides an overview of the history of Ohio’s local public health system and its current status, including structure, governance, funding, and current collaboration.
  • Consolidation: The report identifies current forms of shared public health services in Ohio and assesses future opportunities.
  • Fiscal and Service Issues: The report identifies Ohio’s current funding structure and constraints and recommends ways to improve financing.
  • Governance: The report identifies stakeholder interests and concerns, provides a set of criteria for assessing new models of collaboration or consolidation, and creates a decision-making guide for LHDs to use when moving forward with a new framework.
  • Legal Issues: The report identifies rules, policies, and standards relating to local public health, including a chart of key statutes relevant to local health department governance and cross-jurisdictional sharing.
  • Quality Improvement: Stakeholder consensus recognized that enhancing quality and assuring value were as important as CJS and adopted a vision statement emphasizing the quality of public health services in Ohio.
  • Regionalization: The report identifies current forms of shared public health services in Ohio and assesses future opportunities.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Context and History / Phase One: The report provides an overview of the history of Ohio’s local public health system and its current status, including structure, governance, funding, and current collaboration.
  • Service Implications / Phase Two: The report identifies Ohio’s current funding structure and constraints and recommends ways to improve financing.
  • Governance / Phase Two: the report identifies stakeholder interests and concerns, provides a set of criteria for assessing new models of collaboration or consolidation, and creates a decision-making guide for local health departments to use when moving forward with a new framework.
  • Legal Issues/ Phase Two: The report identifies rules, policies, and standards relating to local public health, including a chart of key statutes relevant to local health department governance and cross-jurisdictional sharing.
  • Implementation and Management / Phase Three: It reports on a proposed model for Ohio’s local governmental public health system.
  • Monitoring and Improving / Phase Three: The proposed model contains activities for improving efficiency and quality.

 

Health Policy Institute of Ohio. (2012). Public Health Futures: Considerations for a New Framework for Local Public Health in Ohio. Columbus, OH: Association of Ohio Health Commissioners, Inc.


Ohio: Cross-Jurisdictional Sharing

Background Information Ohio is served by a decentralized public health system. There are 120 independent local health agencies in the state that are led by local staff. There also are two state-run regional or district offices. Cross-jurisdictional sharing (CJS) has received a great deal of attention in Ohio since 2011. At the time, state law […]

Ohio: Cross-Jurisdictional Sharing

April 19, 2017

Background Information

Ohio is served by a decentralized public health system. There are 120 independent local health agencies in the state that are led by local staff. There also are two state-run regional or district offices.

Cross-jurisdictional sharing (CJS) has received a great deal of attention in Ohio since 2011. At the time, state law allowed the state’s director of health to mandate accreditation, and currently health departments have until July 1, 2020, to become accredited by the Public Health Accreditation Board. Almost simultaneously, the Association of Ohio Health Commissioners released a proposed model for Ohio’s local governmental public health system that includes a mechanism for governance and sustainable financing, considers cross-jurisdictional sharing and/or regionalization, enhances quality and assures value.

The Center’s Resource Library contains additional resources on cross-jurisdictional sharing in Ohio. Click here for information about the legal basis for cross-jurisdictional sharing in Ohio from the Network for Public Health Law.


Examples of CJS Arrangements

Center for Sharing Public Health Services Grantees

Portage County and the cities of Kent and Ravenna
This grantee was part of the Center’s Shared Services Learning Community.
Portage County Health District expanded to include the city of Ravenna, resulting in enhanced services for Ravenna. Simultaneously, the health district and the city of Kent engaged in a joint community health improvement planning process that has successfully engaged numerous partners in countywide efforts to further protect and promote the health of all residents. Select this link to read the Center’s 2017 CJS Case Report about this grantee and to access several policies, procedures, tools and reports associated with their CJS initiative.

Franklin, Delaware and Licking Counties
This grantee was part of the Center’s 2016 Small Grant Program.
Franklin County Public Health and the neighboring health departments in Delaware and Licking Counties collaborated on the planning and implementation of a new solid waste program module in the state’s environmental health database.

Additional Examples

Summit County and the cities of Akron and Barberton

The Consolidation of the Health Departments in Summit County, Ohio
Epilogue: The Consolidating of the Health Departments in Summit County, Ohio
Source: John F. Kennedy School of Government, Harvard University

Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective
Source: Kent State University, College of Public Health, Center for Public Administration and Public Policy

Summit County Health District and Akron Health Department Consolidation Feasibility Study
Source: Center for Community Solutions


Note: This is not a complete list of all CJS arrangements in the state. If you have examples to submit, please contact us at phsharing@khi.org.


Ohio Team Lead Co-Authors Study about Public Health Department Consolidations

John Hoornbeek, team lead of the Northeast Ohio project. John Hoornbeek, Ph.D., team lead of the Northeast Ohio site and director of Kent State’s Center for Public Policy and Health, was principal investigator on a recently completed study about local health department consolidations in Ohio. The study looked at 20 health department consolidations that took […]

Ohio Team Lead Co-Authors Study about Public Health Department Consolidations

October 30, 2013

John Hoornbeek, team lead of the Northeast Ohio project.

John Hoornbeek, Ph.D., team lead of the Northeast Ohio site and director of Kent State’s Center for Public Policy and Health, was principal investigator on a recently completed study about local health department consolidations in Ohio.

The study looked at 20 health department consolidations that took place in Ohio between 2001 and 2012. The purpose of the study was to develop evidence about the effects of health department consolidation on expenditures, revenues and services. It found that community-level factors, such as governance structure and budget status, are useful predictors of consolidation. It also found that total expenditures tend to decrease after a consolidation takes place and that non-local revenues coming into health departments tended to decrease in the first two years post-consolidation. Further research is needed to gain a more complete understanding of the long-term impacts of consolidation on non-local revenues.

“We hope that our work will help inform the policy decisions made by public officials at the local and state levels,” said Hoornbeek.

The study is a joint project of Kent State’s Center for Public Policy and Health and the University of Arkansas for Medical Sciences. Two documents showcase the study’s findings — a policy brief aimed at informing public health practitioners on the study’s findings and a full report, titled “Consolidation of Local Health Departments in Ohio: Motivations and Impacts.”

In August, Hoornbeek participated in a webinar about the study that was hosted by the National Coordinating Center for Public Health Practice-Based Research Networks. Cost estimation methods to predict staffing and spending for public health improvement standards were also discussed in the webinar.

Hoornbeek and study co-authors Stefanak and Michael Morris, professor at the University of Arkansas for Medical Sciences, plan to present their findings at the APHA Annual Conference in Boston this November.

The study was funded through a “quick strike” grant from the Robert Wood Johnson Foundation’s Practice Based Research Network, which is managed by the University of Kentucky and the Ohio Research Association for Public Health Improvement based at Case Western Reserve University.


Public Health Cost Estimation Methods and Consolidation of Local Health Departments in Ohio: Motivation and Impacts

These presentation slides accompany a webinar hosted by the Public Health Practice-Based Research Networks National Coordinating Center. The webinar focused on the use of cost estimation methods to predict staffing and spending for public health improvement standards (using NACCHO core public health services). In addition, results were shared from a study of 20 city-county public […]

Public Health Cost Estimation Methods and Consolidation of Local Health Departments in Ohio: Motivation and Impacts

October 17, 2013

These presentation slides accompany a webinar hosted by the Public Health Practice-Based Research Networks National Coordinating Center. The webinar focused on the use of cost estimation methods to predict staffing and spending for public health improvement standards (using NACCHO core public health services). In addition, results were shared from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to 1) save money, 2) improve services, 3) build long term capacity, and 4) increase efficiency.

Available online: http://phsharing.org/wp-content/uploads/2015/04/OH_PH_Costs_Estimation_Methods_Slides.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: These presentation slides provide results from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to save money.
  • Governance: These presentation slides provide results from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to improve services and build long term capacity.
  • Quality Improvement: These presentation slides provide results from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to increase efficiency.

This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: These presentation slides provide results from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to save money, improve services, build long term capacity, and increase efficiency.
  • Service Implications / Phase Two: These presentation slides provide results from a study of 20 city-county public health department consolidations in Ohio between 2001-2012 that strived to save money.


The Impacts of Local Health Department Consolidation on Public Health Expenditures: Evidence from Ohio

This paper examines the effects of local health department consolidations on the total and administrative expenditures of local health departments in Ohio from 2001 to 2011. Authors found consolidations resulted in reduced expenditures and improvements in services. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355717/pdf/AJPH.2014.302450.pdf It is included in the CJS Resource Library under the categories listed below. Select a […]

The Impacts of Local Health Department Consolidation on Public Health Expenditures: Evidence from Ohio

November 4, 2015

This paper examines the effects of local health department consolidations on the total and administrative expenditures of local health departments in Ohio from 2001 to 2011. Authors found consolidations resulted in reduced expenditures and improvements in services.

Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355717/pdf/AJPH.2014.302450.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Fiscal and Service Issues: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.
  • Regionalization: This article explores consolidation of health departments in Ohio and the cost savings and service improvements that occurred following these efforts.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • What? / Phase One: This report may assist Local Health Departments explore the cost of services and how costs might be affected through cross-jurisdictional sharing.
  • Fiscal / Phase Two: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.
  • Service Implications / Phase Two: This article documents savings experienced by public health departments in Ohio when they consolidated between 2001 to 2011. It also documents service improvements.

 


Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective

This report provides an overview of the eight major strategic and operational challenges the newly formed Summit County Public Health Department faced as it worked through its first year of transition after consolidating three local public health districts into a unified public health organization. The challenges involved implementing new overall strategic decisions, adjusting personnel and […]

Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective

May 17, 2013

This report provides an overview of the eight major strategic and operational challenges the newly formed Summit County Public Health Department faced as it worked through its first year of transition after consolidating three local public health districts into a unified public health organization. The challenges involved implementing new overall strategic decisions, adjusting personnel and facilities, converting technological systems, managing changing organizational cultures, and communicating with key stakeholders and staff. The report details how these challenges were addressed, progress to date, and overall outcomes and accomplishments.

Available online (pdf): http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/lhd/Final%20SCPH%20Report.ashx

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Accreditation / Essential Services: The report mentions that the department has applied for accreditation by PHAB, one of the early departments in the country to do so. It assesses the consolidation’s impact on public health programmatic capacities and expertise and on provision of public health services.
  • Background / History: The article describes the reasons for and steps leading to the consolidation of three public health districts in Ohio to form the Summit County Public Health Department.
  • Change Management: The report addresses the need to adjust employee roles, locations and salaries; integrate and convert technologies; and relocate facilities.
  • Communications: The report details efforts to improve the operational challenge most commonly mentioned to researchers, which is communications and engagement with staff.
  • Consolidation: The report discusses perceptions of goals of the consolidation and the pace of progress.
  • Fiscal and Service Issues: The report summarizes results of a report of cost savings achieved after consolidation and changes in external grant funding during the same period.
  • Governance: The report provides a chart and description of the duties of the new organizational structure put in place after the consolidation and details development of a new strategic plan and work to build credibility and engage key external stakeholders.
  • Monitoring and Improving: The report was prepared at the request of the Summit County Public Health Department to assess its first year post-consolidation.
  • Research and Evaluation: The report provides details of the researchers’ collection of data by reviewing key documents, interviewing managers and stakeholders, surveying members of the boards of health for the consolidating units, and conducting focus groups and a survey of staff members.

 

This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Context and History / Phase One: The article describes the reasons for and steps leading to the consolidation of three public health districts in Ohio to form the Summit County Public Health Department.
  • Fiscal / Phase Two: It summarizes results of a report of cost savings achieved after consolidation and changes in external grant funding during the same period.
  • Service Implications / Phase Two: It summarizes results of a report of cost savings achieved after consolidation and changes in external grant funding during the same period.
  • Governance / Phase Two: The report provides a chart and description of the duties of the new organizational structure put in place after the consolidation and details development of a new strategic plan and work to build credibility and engage key external stakeholders.
  • Logistical Issues / Phase Two: The report details how challenges were addressed, progress to date, and overall outcomes and accomplishments.
  • Communications / Phase Two: The report details efforts to improve the operational challenge most commonly mentioned to researchers, which is communications and engagement with staff.
  • Change Management / Phase Two: It addresses the need to adjust employee roles, locations and salaries; integrate and convert technologies; and relocate facilities.
  • Performance Measurement / Phase Two: This report was prepared at the request of the Summit County Public Health Department to assess its first year post-consolidation.
  • Implementation and Management / Phase Three: The report addresses how challenges were met involving implementing new overall strategic decisions, adjusting personnel and facilities, converting technological systems, managing changing organizational cultures, and communicating with key stakeholders and staff.
  • Communications and Change Management / Phase Three: It addresses the need to adjust employee roles, locations and salaries; integrate and convert technologies; and relocate facilities.
  • Monitoring and Improving / Phase Three: This report was prepared at the request of the Summit County Public Health Department to assess its first year post-consolidation.

 

Hoornbeek, J., Budnik, A., Beechey, T., & Filla, J. (2012). Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective. Kent, OH: Kent State University, College of Public Health, Center for Public Administration and Public Policy.

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Policy Brief–Consolidation of Local Health Departments in Ohio: Motivations and Impacts

This report examines the motivations for and impacts of consolidations of local public health departments in Ohio. Since 2001, there have been twenty cases of city health departments merging their public health services with those of a county health department or another city health department in Ohio, and this has resulted in a 13 percent […]

Policy Brief–Consolidation of Local Health Departments in Ohio: Motivations and Impacts

October 17, 2013

This report examines the motivations for and impacts of consolidations of local public health departments in Ohio. Since 2001, there have been twenty cases of city health departments merging their public health services with those of a county health department or another city health department in Ohio, and this has resulted in a 13 percent decrease in the number of local health departments. Issues involving expenditures, workforces and service delivery are examined.

Available online (pdf): http://www2.kent.edu/cpph/upload/finalraphi-lhdconsolidationsummer2013.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Consolidation: This report examines the impact of consolidation on health departments in Ohio.
  • Fiscal and Service Issues: This report examines the impact of consolidation on services and spending.
  • Quality Improvement: This study reports improved services as a result of consolidation
  • Research and Evaluation: It presents research findings from combined administrative data and from interviews with local health directors

 

This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

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Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective

This presentation is part of a panel discussion entitled, “You’re Not Alone: Dialogue about Cross-Jurisdictional Sharing.” The discussion occurred during the National Association of County and City Health Officials annual meeting on July 12, 2012, in Los Angeles, CA. A county-level policymaker from Ohio who participated in the implementation of cross-jurisdictional sharing (CJS) of public […]

Consolidating Health Departments in Summit County, Ohio: A One Year Retrospective

May 17, 2013

This presentation is part of a panel discussion entitled, “You’re Not Alone: Dialogue about Cross-Jurisdictional Sharing.” The discussion occurred during the National Association of County and City Health Officials annual meeting on July 12, 2012, in Los Angeles, CA. A county-level policymaker from Ohio who participated in the implementation of cross-jurisdictional sharing (CJS) of public health services in his county shares lessons learned from the CJS implementation process, discusses changes that occurred in public health services, outlines the overall impact of CJS implementation, and provides considerations for new frameworks for local public health in Ohio.

Available online (pdf): http://www.phsharing.org/wp-content/uploads/2013/05/2012-PD24-Nixon-NACCHO-Youre-Not-Alone-July-2012.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 

Nixon. G. (2012). You’re Not Alone: Dialogue about Cross-Jurisdictional Sharing [presentation slides]. Akron, OH: Summit County Public Health.


Summary of Outreach Efforts (Ohio)

This report provides an overview of the multiple efforts of outreach to public health stakeholders and others with public health interests in Portage County, Ohio and elsewhere, undertaken by the Portage County Shared Services Team in four focused outreach engagement areas: Engaging the Task Force for Improving Public Health in Portage County, the Robert Woods […]

Summary of Outreach Efforts (Ohio)

April 29, 2015

This report provides an overview of the multiple efforts of outreach to public health stakeholders and others with public health interests in Portage County, Ohio and elsewhere, undertaken by the Portage County Shared Services Team in four focused outreach engagement areas: Engaging the Task Force for Improving Public Health in Portage County, the Robert Woods Johnson Foundation Northeast Ohio Site Visit, Community Health Assessment (CHA) Partnership Initial Outreach, and Community Health Assessment Public Comment Outreach.

Available online: http://phsharing.org/wp-content/uploads/2015/04/Summary_Outreach_Efforts.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: This brief document provides highlights and background about the focused community outreach engagement efforts undertaken by the Portage County (Ohio) Shared Services Team.

 


The Center Visits Northeast Ohio

John Hoornbeek (standing on right), Associate Professor at Kent State University, is the project lead for the Ohio site. In December 2013, the Center for Sharing Public Health Services visited the Shared Services Learning Community (SSLC) team in Northeast Ohio, where three health departments that cover Portage County are considering cross-jurisdictional sharing (CJS) arrangements as […]

The Center Visits Northeast Ohio

February 5, 2014

John Hoornbeek (standing on right), Associate Professor at Kent State University, is the project lead for the Ohio site.

In December 2013, the Center for Sharing Public Health Services visited the Shared Services Learning Community (SSLC) team in Northeast Ohio, where three health departments that cover Portage County are considering cross-jurisdictional sharing (CJS) arrangements as a way to improve effectiveness and efficiency. A team from Kent State University acts as convener and provides knowledge, best practices and staffing. John Hoornbeek, Associate Professor at Kent State University, is the project lead.

In addition to Center staff, the site visit team included six visitors from two peer sites. Doug Tucker, County Commissioner in Carbon County, attended from the Montana site. Sharon Braaten and Sandy Tubbs, team leads for the Horizon Minnesota site, also attended, along with public health nurses Connie Bullock, Betsy Hills and Crystal Wagar.

As part of the site visit, the Ohio team invited the visitors to meet with staff in neighboring Summit County, where three health departments were recently consolidated into one. Some of the site visitors found this conversation especially timely. As one of them stated shortly after the visit, “It was very beneficial to visit with peers at Summit County and hear real comments about how the transition took place.”

Site visits and other peer discussions provide valuable learning opportunities. We encourage you to talk with sites that are experiencing issues similar to your own. To connect with a specific SSLC team or Center staff, please contact us at phsharing@khi.org.


Northeast Ohio

Photo by Kent State University. Northeast Ohio Center’s Site Summary Email Project Team Download Project Description Site Visit Report Articles and Resources Title: Developing an informed and shared approach to effective delivery of public health services in Portage County, Ohio A recent Task Force report called for Portage County Health District and the Ravenna and […]

Northeast Ohio

February 15, 2013

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Photo by Kent State University.

Northeast Ohio

Title: Developing an informed and shared approach to effective delivery of public health services in Portage County, Ohio

A recent Task Force report called for Portage County Health District and the Ravenna and Kent city health departments to consider entering into a cross jurisdictional sharing (CJS) arrangement for the delivery of public health services across the jurisdictions.  A project team led by Kent State University Foundation will work with the Task Force to inventory and evaluate current CJS arrangements, analyze CJS models for their potential use, and develop a strategic action plan for implementing the preferred CJS model.

The $125,000 grant supports the analysis and development of a CJS model among two city health departments and one county health district serving more than 160,000 people in one county and two cities.


Final Report on the Feasibility of the Consolidation of the Findlay City Health District and the Hancock County (Ohio) General Health District into a Combined General Health District

This report, funded in part by NALBOH, documents a feasibility study of issues and options involved in the creation of a city / county health district consolidation. Call the Center for Sharing Public Health Services for more information about this publication. It is included in the CJS Resource Library under the categories listed below. Select […]

Final Report on the Feasibility of the Consolidation of the Findlay City Health District and the Hancock County (Ohio) General Health District into a Combined General Health District

May 17, 2013

This report, funded in part by NALBOH, documents a feasibility study of issues and options involved in the creation of a city / county health district consolidation.

Call the Center for Sharing Public Health Services for more information about this publication.

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Consolidation: This report reviewed the rationale for consolidation.
  • Fiscal and Service Issues: This report reviewed financial operations and combined department financial projections.
  • Governance: This report reviewed governance of a consolidated health district.
  • Legal Issues: This report reviewed the essential elements of a contract agreement to create a combined general health district.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

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  • Fiscal / Phase Two: This report reviewed financial operations and combined department financial projections.
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  • Service Implications / Phase Two: This report reviewed financial operations and combined department financial projections.
  • Logistical Issues / Phase Two: This feasibility study focused on: rationale for consolidation, existing environment and culture; overview of the programs and services in Findlay City Health District and the Hancock County (Ohio) General Health District; financial operations overview and combined department financial projections; facilities and space; personnel issues; governance of a consolidated health district; and essential elements of a contract agreement to create a combined general health district.

 

National Association of Local Boards of Health. (2007). Final Report on the Feasibility of the Consolidation of the Findlay City Health District and the Hancock County (Ohio) General Health District is not a Combined General Health District. Bowling Green, OH: National Association of Local Boards of Health.


Center for Sharing Public Health Services Announces Newest Grantees

Eleven teams will focus on cross-jurisdictional sharing in public health July 18, 2017 The Center for Sharing Public Health Services (the Center) has selected eleven public health teams to participate in a new funding initiative focused on cross-jurisdictional sharing (CJS) in public health. CJS occurs when jurisdictions, such as counties or cities, collaborate to deliver […]

Center for Sharing Public Health Services Announces Newest Grantees

July 21, 2017

Eleven teams will focus on cross-jurisdictional sharing in public health

July 18, 2017

The Center for Sharing Public Health Services (the Center) has selected eleven public health teams to participate in a new funding initiative focused on cross-jurisdictional sharing (CJS) in public health. CJS occurs when jurisdictions, such as counties or cities, collaborate to deliver public health services across boundaries. By working together, public health agencies can build economies of scale that improve effectiveness and efficiency.

As part of the program, the eleven teams will receive grant funding and one-on-one technical assistance from the Center. The Center will get the opportunity to observe progress and to capture learning that it will use to develop and disseminate new tools and resources and to provide technical assistance to other jurisdictions that are considering or adopting CJS approaches.

“The teams were selected because their work focuses on areas the Center has prioritized for further study,” explained Gianfranco Pezzino, co-director of the Center. “For example, several of the teams are composed of smaller jurisdictions interested in using CJS strategies to provide a broader range of public health services.”

“In another example, some of the teams are working toward system-wide public health improvement at the state level, using a CJS approach,” added Patrick Libbey, who is also a co-director of the Center.

The following public health teams have been selected to participate in the new program:

  • Colorado: West Central Public Health Partnership—This partnership, which comprises six frontier and rural counties, is seeking to improve communications among member counties and to assess the effectiveness of and capacity for shared services and activities. The following counties participate in the partnership: Delta, Gunnison, Hinsdale, Montrose, Ouray and San Miguel.
  • Colorado: San Luis Valley Public Health Partnership—This partnership, which comprises three frontier and three rural counties, will develop and implement a cross-jurisdictional data collection and management system. The following counties participate in the partnership: Alamosa, Conejos, Costilla, Mineral, Saguache and Rio Grande.
  • Florida: Capital Consortium—Ten health departments will evaluate how well their shared information technology (IT) support model is performing and identify needed improvements. The initiative covers Leon, Calhoun, Liberty, Gadsden, Jefferson, Madison, Taylor, Wakulla, Franklin and Gulf Counties. It also involves the Florida Department of Health and the Florida Capital Consortium IT Regional Office.
  • Kansas: American Heart Association—The American Heart Association in Kansas is working on behalf of the four federally recognized Native American Tribes in the state—Iowa Tribe of Kansas and Nebraska, Kickapoo Tribe in Kansas, Prairie Band Potawatomi Nation, and the Sac and Fox Nation of Missouri in Kansas and Nebraska. The tribes are developing a data-sharing arrangement, and they are using a research project on tribal youths’ perception of health as the basis for the arrangement.
  • Kentucky: Tri-County Fitness Challenge—Three local health departments will develop an agreement to support future CJS efforts, starting with a tri-county fitness challenge. The initiative covers Bourbon, Clark and Montgomery Counties, with assistance from the University of Kentucky.
  • Nebraska: Nebraska Association of Local Health Departments (NALHD)—NALHD is leading a project to develop a model website for local health departments. It will be pilot tested by Central District Health Department, North Central District Health Department, Northeast Nebraska Public Health Department, Panhandle Public Health District and South Heartland District Health Department. Additional health departments may choose to launch similar websites in the future.
  • Ohio: Ohio Public Health Partnership (OPHP)—OPHP is a coalition comprising the Association of Ohio Health Commissioners (AOHC), Ohio Association of Boards of Health (OABH), Ohio Environmental Health Association (OEHA), Ohio Public Health Association (OPHA) and Ohio Society for Public Health Education (SOPHE). OPHP will analyze the extent to which local health departments seek to share foundational public health services that meet the Public Health Accreditation Board’s standards and measures. It will then develop a template MOU that can be scaled to facilitate CJS arrangements for these services.
  • Oregon: Clatsop and Columbia Counties—Health departments and behavioral health agencies in Clatsop and Columbia Counties will develop a regional model of a case referral and management program for kids with special health needs.
  • Oregon: Polk and Marion Counties—Polk County and contiguous Marion County will explore the feasibility of cross-jurisdictional sharing and anticipate identifying a specific shared service in the process.
  • Washington: Washington State Department of Health—Washington State Department of Health is collaborating with Public Health Centers for Excellence and Washington State Association of Local Public Health Officials to improve the statewide immunization program. The project partners will develop a pilot program to test a regional approach to administering the Vaccines for Children (VFC) program and the Assessment, Feedback, Incentives eXchange (AFIX) program’s quality improvement activities.
  • Washington, D.C.: Center for State and Local Government Excellence (SLGE)—SLGE, a nonprofit, nonpartisan organization that helps state and local governments become excellent employers so they can attract and retain talented public servants, will develop three case studies focused on sharing local public health department personnel.

 
The Center, which serves as a national resource on CJS, is managed by the Kansas Health Institute with support from the Robert Wood Johnson Foundation. The National Network of Public Health Institutes is the Center’s administrative partner for this effort and awards and administers all grants.

Download a full copy of the press release.


Epilogue: The Consolidating of the Health Departments in Summit County, Ohio

This briefing report is a retrospective review of the process, challenges and outcomes of the consolidation of three health departments. Available online (pdf): http://www.phsharing.org/wp-content/uploads/2013/02/Summit-County-Epilogue-1-23-13.pdf It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category. Accreditation / Essential Services: Mentions consolidated entity’s application […]

Epilogue: The Consolidating of the Health Departments in Summit County, Ohio

May 17, 2013

This briefing report is a retrospective review of the process, challenges and outcomes of the consolidation of three health departments.

Available online (pdf): http://www.phsharing.org/wp-content/uploads/2013/02/Summit-County-Epilogue-1-23-13.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Harvard Kennedy School. (2012). Epilogue: The Consolidation of the Health Departments in Summit County, Ohio. Boston, MA: Harvard University, John F. Kennedy School of Government.

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The Consolidation of the Health Departments in Summit County, Ohio

This report provides a historical narrative of the process of consolidating three local health departments into one for an entire county. It provides details of how the political, legal, fiscal and administrative challenges to obtaining approval of the merger and of implementing it were met. Available online (pdf): http://www.phsharing.org/wp-content/uploads/2013/02/Summit-County-Case-1.23.13.pdf It is included in the CJS […]

The Consolidation of the Health Departments in Summit County, Ohio

This report provides a historical narrative of the process of consolidating three local health departments into one for an entire county. It provides details of how the political, legal, fiscal and administrative challenges to obtaining approval of the merger and of implementing it were met.

Available online (pdf): http://www.phsharing.org/wp-content/uploads/2013/02/Summit-County-Case-1.23.13.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Background / History: This report provides a detailed history of political and legal barriers that had to be overcome to approve the merger and implement it.
  • Consolidation: This report provides details of the process of consolidation of one county public health department with two city public health departments.
  • Fiscal and Service Issues: This report discusses how the three entities’ budgets and funding streams impact the merger.
  • Governance: This report describes conflicts among the three parties in relation to the proposed merger and compromises that allowed them to create a consolidated public health department.
  • Legal Issues: Multiple legal and legislative issues had to be overcome including adjusting employment contracts for the new entity.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Harvard Kennedy School. (2012). The Consolidation of the Health Departments in Summit County, Ohio. Boston, MA: Harvard University, John F. Kennedy School of Government.


Report–Consolidation of Local Health Departments in Ohio: Motivations and Impacts

This policy brief reviews motivations and impacts for consolidation of local public health departments in Ohio. It indicates that health departments often seek to save money and improve services through consolidation, and that overall city government factors such as budget deficits and the structure of the city leadership are influential in promoting consolidations. Available online […]

Report–Consolidation of Local Health Departments in Ohio: Motivations and Impacts

October 17, 2013

This policy brief reviews motivations and impacts for consolidation of local public health departments in Ohio. It indicates that health departments often seek to save money and improve services through consolidation, and that overall city government factors such as budget deficits and the structure of the city leadership are influential in promoting consolidations.

Available online (pdf): http://du1ux2871uqvu.cloudfront.net/sites/default/files/file/Consolidation%20of%20Local%20Health%20Departments%20in%20Ohio.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Consolidation: Interviewees reported that their consolidations have been successful in achieving their fiscal and service goals more than 90 percent of the time.
  • Fiscal and Service Issues: Research results indicate that consolidation is associated with a significant reduction in per capita total expenditures and that the consolidations did not lead to increases in the tax burden for public health services on the county jurisdictions.
  • Governance: This study examines implications of consolidation for local public health expenditures, workforce and service.
  • Research and Evaluation: Researchers used data obtained through interviews conducted with senior county health department officials and statistical analyses of administrative data.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Fiscal / Phase Two: Research results indicated that consolidation is associated with a significant reduction in per capita total expenditures and that the consolidations did not lead to increases in the tax burden for public health services on the county jurisdictions.
  • Service Implications / Phase Two: Research results indicated that consolidation is associated with a significant reduction in per capita total expenditures and that the consolidations did not lead to increases in the tax burden for public health services on the county jurisdictions.
  • Workforce Issues / Phase Two: This resource relates to workforce issues.
  • Governance / Phase Two: This study examines implications of consolidation for local public health expenditures, workforce and service.
  • Monitoring and Improving / Phase Three: Ongoing monitoring is needed but initial research results suggest that while the consolidations that occurred did not end up costing township and municipal residents within the county jurisdictions more money, the consolidations do not appear to have resulted in reduced taxes for public health services either.

 


Current Cross-Jurisdictional LHD Collaborations in Ohio Survey

This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among jurisdictions in an effort to determine interest in working together. It can be used as an assessment tool to determine what public health services may be offered in some jurisdictions and not offered in others to initiate discussion around potential sharing […]

Current Cross-Jurisdictional LHD Collaborations in Ohio Survey

July 22, 2014

This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among jurisdictions in an effort to determine interest in working together. It can be used as an assessment tool to determine what public health services may be offered in some jurisdictions and not offered in others to initiate discussion around potential sharing arrangements. It can be used as an initial tool to gather information among jurisdictions and to promote further discussion.

Available online (pdf): http://www.phsharing.org/wp-content/uploads/2014/07/Current_CJ_LHD_Collaborations_Ohio_Survey.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Environmental Issues: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of environmental services.
  • Fiscal and Service Issues: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health and fiscal services.
  • Legal Issues: This Cross-Jurisdictional LHD Collaborations Survey asks about the legal and statute-related issues regarding the provision of public health services.
  • Preparedness / Emergency Response: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of emergency preparedness services.
  • Rural / Small Jurisdictions: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among rural jurisdictions.
  • Surveillance / Data Sharing: This Cross-Jurisdictional LHD Collaborations Survey asks about surveillance and data sharing related to public health services.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Why? / Phase One: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among multiple jurisdictions in an effort to determine interest in working together.
  • What? / Phase One: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among jurisdictions in an effort to determine in which services there might be interest in working together.
  • Who? / Phase One: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health services among jurisdictions in an effort to determine who might be interested in working together
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  • Service Implications / Phase Two: This Cross-Jurisdictional LHD Collaborations Survey asks about the provision of public health and fiscal services.

 


Resource Sharing Among Ohio’s Local Health Departments: April, 2013

The report explores local health departments in Ohio. It emphasizes the importance of collaboration and resource sharing among LHDs in order to facilitate the provision of the minimum package of local public health services most efficiently. Available online: http://www.communitysolutions.com/assets/docs/Major_Reports/State_Budget_and_tax/publichealthfinal4.12.13.pdf It is included in the CJS Resource Library under the categories listed below. Select a link […]

Resource Sharing Among Ohio’s Local Health Departments: April, 2013

June 8, 2015

The report explores local health departments in Ohio. It emphasizes the importance of collaboration and resource sharing among LHDs in order to facilitate the provision of the minimum package of local public health services most efficiently.

Available online: http://www.communitysolutions.com/assets/docs/Major_Reports/State_Budget_and_tax/publichealthfinal4.12.13.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.


CJS Case Report: Ohio’s Portage County

Portage County Health District expanded to include the city of Ravenna, resulting in enhanced services for Ravenna. Simultaneously, the health district and the city of Kent engaged in a joint community health improvement planning process that has successfully engaged numerous partners in countywide efforts to further protect and promote the health of all residents. Available […]

CJS Case Report: Ohio’s Portage County

May 5, 2017

Portage County Health District expanded to include the city of Ravenna, resulting in enhanced services for Ravenna. Simultaneously, the health district and the city of Kent engaged in a joint community health improvement planning process that has successfully engaged numerous partners in countywide efforts to further protect and promote the health of all residents.

Available online: http://phsharing.org/wp-content/uploads/2018/02/OhioCaseReportFebruary2018.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.


Evaluation Workgroup Report (Ohio)

The Evaluation Workgroup was tasked with evaluating collaborations among the three health districts in Portage County, and with providing recommendations to local health officials on ways to improve those collaborative relationships. To develop the recommendations, workgroup members engaged in a series of activities with assistance from Kent State University’s Center for Public Policy and Health […]

Evaluation Workgroup Report (Ohio)

April 29, 2015

The Evaluation Workgroup was tasked with evaluating collaborations among the three health districts in Portage County, and with providing recommendations to local health officials on ways to improve those collaborative relationships. To develop the recommendations, workgroup members engaged in a series of activities with assistance from Kent State University’s Center for Public Policy and Health (KSU-CPPH) staff, including developing an inventory of health department services that were provided collaboratively and independently, and performing an evaluation of those collaborations. This process resulted in recommendations that are presented within the report.

Available online: http://phsharing.org/wp-content/uploads/2015/01/OH_Evaluation_Workgroup_Report.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Monitoring and Improving: The Evaluation Workgroup inventoried existing collaborations among the Portage County Health Departments (Portage County, Kent, and Ravenna), assessed their implementation, and devised means by which collaborative efforts among departments in the County could be improved.
  • Research and Evaluation: The Evaluation Workgroup was charged with inventorying collaborative endeavors among health departments in Portage County, developing criteria for assessing the current collaborative endeavors, and providing recommendations for improvement in this are

 


Center Presents at APHA Annual Meeting and NNPHI COPPHI Open Forum for Quality Improvement in Public Health

Participants at the APHA Annual Meeting include: (pictured on top, left to right) Matt Stefanak, John Hoornbeek, Pat Libbey, (pictured on bottom, left to right) Gianfranco Pezzino, Brennan Rhodes-Bratton and Derek Brindisi. Participants at the NNPHI COPPHI Open Forum for Quality Improvement in Public Health: (pictured from left to right) Ken Oakley, Sandy Tubbs and Gianfranco Pezzino. Two team leads from […]

Center Presents at APHA Annual Meeting and NNPHI COPPHI Open Forum for Quality Improvement in Public Health

December 5, 2013

Participants at the APHA Annual Meeting include: (pictured on top, left to right) Matt Stefanak, John Hoornbeek, Pat Libbey, (pictured on bottom, left to right) Gianfranco Pezzino, Brennan Rhodes-Bratton and Derek Brindisi.


Participants at the NNPHI COPPHI Open Forum for Quality Improvement in Public Health: (pictured from left to right) Ken Oakley, Sandy Tubbs and Gianfranco Pezzino.

Two team leads from CJS projects presented at the American Public Health Association Annual Meeting held November 2-6 in Boston. John Hoornbeek, team lead for the Northeast Ohio project, presented Twenty-First Century Health Department Consolidations in Ohio: Perspectives from Participants. Derek Brindisi, team lead for the Central Massachusetts Regional Public Health Alliance, presented Implementing Mobilizing for Action through Partnerships and Participation (MAPP) to Achieve a 21st Century City Health Department. 

The National Network of Public Health Institutes (NNPHI) hosted the Community of Practice for Public Health Improvement (COPPHI) Open Forum for Quality Improvement (QI) in Public Health on November 20-21 in Memphis. The Center and four CJS projects were invited to attend this meeting. Gianfranco Pezzino, Center Co-Director, along with Sandy Tubbs, co-lead of the Horizon Minnesota project, and Ken Oakley, team lead with the Genesee/ Orleans Counties Public Health New York project, discussed issues that rural states and jurisdictions face in CJS arrangements. They also talked about how CJS efforts relate to accreditation. John Hoornbeek, team lead with the Northeast Ohio project, Shane Gallagher, team member with the Cumberland County Maine CJS project, and Deb Burns, team lead of the Minnesota System Wide Project, provided insight about their projects as audience participants.

 

 

 



Summit County Health District and Akron Health Department Consolidation Feasibility Study

This is a report on a feasibility study for the Summit County Health District (Ohio) and the Akron Health Department that examined the critical issues that could support or impede a successful merger with guidance from the health care community. The critical issues addressed include: governance, personnel, finance, public health services, facilities, legal issues, timetable […]

Summit County Health District and Akron Health Department Consolidation Feasibility Study

May 17, 2013

This is a report on a feasibility study for the Summit County Health District (Ohio) and the Akron Health Department that examined the critical issues that could support or impede a successful merger with guidance from the health care community. The critical issues addressed include: governance, personnel, finance, public health services, facilities, legal issues, timetable and target dates, and community and stakeholder participation.

Available online (pdf):  https://www.odh.ohio.gov/localhealthdistricts/Futures/sitecore/shell/Controls/Rich%20Text%20Editor/-/media/ODH/ASSETS/Files/lhd/SCHD-Feasibility-Study-Final-Report-2-12-10.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

 

Ackerman, S., Feinn, W., & Slenkovich, K. (2010). Summit County Health District and Akron Health Department Consolidation Feasibility Study. Cleveland, OH: Center for Community Solutions.


Ordinance Authorizing the Provision of Health Services: Portage County/City of Ravenna

This ordinance authorized a city official (the mayor) to enter into an agreement with the county health district to provide its health services because the city is without the ability to do so to meet the Ohio Revised Code and Sanitary Code. It also includes the agreement that outlines the provision of those public health […]

Ordinance Authorizing the Provision of Health Services: Portage County/City of Ravenna

May 22, 2015

This ordinance authorized a city official (the mayor) to enter into an agreement with the county health district to provide its health services because the city is without the ability to do so to meet the Ohio Revised Code and Sanitary Code. It also includes the agreement that outlines the provision of those public health services.

Available online: http://phsharing.org/wp-content/uploads/2015/05/OrdinancePortageR.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Governance: This document provides an example of a governmental ordinance authorizing a city official to enter into an agreement with a county government to provide public health services.
  • Legal Sharing Agreements: This document provides an example of the initial ordinance allowing and resulting in an agreement outlining the provision of public health services by a county health district for a city health department because the city is without ability to provide those services as specified in state codes.

 
This resource is also linked to the Roadmap. Select a link below to read more about each area.

  • Legal Sharing Agreement / Phase Two: This document provides an example of the initial ordinance allowing and resulting in an agreement outlining the provision of public health services by a county health district for a city health department because the city is without ability to provide those services as specified in state codes.

 

Complete Title: Ordinance No. 2015-034 An Ordinance Authorizing the Mayor to Enter into an Agreement with the Portage County Combined General Health District, to Provide Health Services to the Citizens of the City of Ravenna, Ohio, and Declaring an Emergency


Portage County Community Health Assessment

This report presents the results of Portage County’s collaborative community health assessment (CHA). Its purposes are to: (1) help create a shared understanding of health needs in Portage County and the local public health system’s future information collection needs and (2) create a foundation for future public health improvements by informing a Community Health Improvement […]

Portage County Community Health Assessment

April 29, 2015

This report presents the results of Portage County’s collaborative community health assessment (CHA). Its purposes are to: (1) help create a shared understanding of health needs in Portage County and the local public health system’s future information collection needs and (2) create a foundation for future public health improvements by informing a Community Health Improvement Planning (CHIP) process and enabling a continuing quality improvement process for the local public health system.

Available online (The file has been divided into two files for easier downloading):
Part 1: Main Report: http://phsharing.org/wp-content/uploads/2015/04/PortageCountyCHA.pdf
Part 2: Appendices: http://phsharing.org/wp-content/uploads/2015/04/PortageCountyCHAAppendices.pdf

It is included in the CJS Resource Library under the categories listed below. Select a link to find other resources in that category.

  • Research and Evaluation: The report identifies a list of 46 substantiated health needs in 9 broad areas within Portage County (Ohio), and an identification of potential strategies for improving data collection to inform future health assessment rounds.ere

 


Central Massachusetts Site Visit

The Central Massachusetts Regional Public Health Alliance hosted a site visit in September. The Center for Sharing Public Health Services visited the Shared Services Learning Community site in Central Massachusetts on September 9-10, 2014. Derek Brindisi, Director of Worcester’s Division of Public Health, is leading this effort. Members from three other demonstration sites — Cumberland […]

Central Massachusetts Site Visit

December 29, 2014


The Central Massachusetts Regional Public Health Alliance hosted a site visit in September.

The Center for Sharing Public Health Services visited the Shared Services Learning Community site in Central Massachusetts on September 9-10, 2014. Derek Brindisi, Director of Worcester’s Division of Public Health, is leading this effort. Members from three other demonstration sites — Cumberland County, Maine; Minnesota System Wide; and Northeast Ohio — also participated in the site visit.

The Central Massachusetts Regional Public Health Alliance is a partnership of seven jurisdictions. Worcester Division of Public Health leads the alliance and also provides environmental health and other public health services in the other towns, which include Grafton, Holden, Leicester, Millbury, Shrewsbury, and West Boylston. As a result of the alliance, some towns receive public health services that weren’t available in the past and environmental health service provision has been standardized throughout the region. The alliance is pursuing PHAB accreditation through Worcester’s Division of Public Health.

The full site visit report will be posted soon on the Central Massachusetts page of our website.


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