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D SMALL GROUP EXERCISE INSTRUCTIONS and WORKSHEET Tabletop Exercise: Toward a Population Health Workforce Issue Go with the issue group identified on your packet 1. School absenteeism 2. Affordable housing 3. Food security Convener(s) Who will be the convener? Suggestions: (e.g., county executive; regional health system; â¢ Consider circumstances where major regional nonprofit [e.g., Y organization or an âhonest brokerâ could be a chamber of commerce]) helpful. â¢ Convener invites people to the table, with attention to power imbalances, considers the levers each participant can activate. Broad The broad approach (e.g., multifaceted solution Suggestions: âapproachâ to the issue) does not need to be specified but â¢ Consider that for the three broad refers to the higher-order initiative or effort that issues identified above, a workforce strategies are part of (e.g., a collective workforce strategy will generally impact effort, a community development plan) be part of a broader approach Strategies: (e.g., a workforce plan, (e.g., a major initiative for policy communication campaign, training program, change, economic development). [under]graduate dual degree program) â¢ Set the context for the broader Tactics: (e.g., CHW training, advocacy training, approach, but your focus should HIA training; public education effort or be on the workforce strategies community deliberation; on-the-job certification that will be needed. Identify [HIA, land use]; dual degree curriculum) tactics and partners for each. â¢ Try to include all three Responsible partner(s): place of worship, categories on todayâs agenda school of public health, community-based (e.g., health sector, CHWs and organization, foundation, CDFI, supermarket, others, cross-sector) in your other business, health system workforce strategies. Funding How will you pay for this? (e.g., community benefit, property tax, new market tax credit, government or foundation grant, financing package from public and private sources) Given your background and what you heard today, how would you approach the issue? Draw on any knowledge they have of an evidence base that supports particular initiatives/approaches? If you are a CHW/educator/health official, you could play that role. Or, if a different role is needed in your group, draw on your knowledge to role-play that. â¢ Please apply a health equity perspective to your discussion and role-play. 75 PREPUBLICATION COPY: UNCORRECTED PROOFS
76 WORKFORCE FOR POPULATION HEALTH IMPROVEMENT 1 EDUCATION Chronic absenteeism (missing 10 percent or more of school days1 or 15 days or more)2 is a major challenge in Ourtown, USA, population 250,000. About 1 in 4 children in the Ourtown public schools miss 20.5 or more days of school a year. School absenteeism has been found to be fourfold higher in students from low-income families, where factors such as housing instability or inadequacy, health issues (e.g., asthma), safety concerns, and family unemployment can be important contributors. For children, absenteeism is associated with delayed reading, school failure, and dropout. Children who are absent in preschool, kindergarten, or first grade are much less likely to read at grade level by third grade and four times more likely to drop out of school. Absenteeism is associated with a loss of state funding for schools, which can amount to hundreds of thousands of dollars each year, limiting their ability to provide adequate educational resources to pupils.3 Last month, a summit on absenteeism was convened. The opening speaker asked âWhose primary job is it to focus on absenteeism?â; nobody raised a hand. Educators said their job was to teach students, clinicians said their job was to provide medical attention, and community leaders said their job was to support families through job training and other economic development. Assembled leaders urged the county executive to call for a plan to end absenteeism. Under that plan, please describe workforce strategies and tactics and designate the partner(s) responsible for each. Then explain how a newly empowered workforce across all three areas (if desired, or pick one) can come together and be held accountable in support of this effort. Please also add your suggestions for how this plan could be financed. 1 See https://www2.ed.gov/datastory/chronicabsenteeism.html (accessed September 27, 2019). 2 See https://healthyschoolscampaign.org/wp-content/uploads/2018/10/Education-Data-for-Health-Systems-Report- 10-9-18.pdf (accessed September 27, 2019). 3 See https://www.rwjf.org/en/library/research/2016/09/the-relationship-between-school-attendance-and-health.html (accessed September 27, 2019). PREPUBLICATION COPY: UNCORRECTED PROOFS
APPENDIX D 77 2 AFFORDABLE HOUSING Housing affordability is a major concern in Ourtown, USA. Areas of this city of 500,000 are rapidly gentrifying, and high-priced condominiums are displacing lifelong residents. Rents have increased more than 50 percent over the last 5 years, and incomes have not kept up for many city residentsânearly 60 percent of Ourtown residents are rent burdened, meaning that their rent consumes more than half of their income. Combined with a growing population of unhoused residents, the need for housing has never been greater.4 Over the last several years, local social service organizations, the health department, and the media have called attention to the growing housing crisis in the city. A wide range of partners came together to identify an approach to expand truly affordable housing in Ourtown. The facilitator at the kickoff meeting asked âWhose primary job is housing?â The department of housing and community development said âitâs our main job, but we canât do it alone.â The health system CEO said that its community health needs assessment (and extensive news media coverage) had identified housing as a major need and also learned that 10 percent of ED admissions are either homeless or at risk of homelessness,5 and after further research and dialogue, the systemâs board decided to make a major investment. âHousing clearly is a health issue,â the hospital leadership said, âbut weâre not housing experts, and weâre glad to be part of this broad coalition to tackle this issue.â The areaâs renewable energy co-op became involved with the emerging housing coalition to inform efforts to make affordable housing sustainable for residents. The coalition steering group called for a comprehensive affordable housing plan. Please describe workforce strategies and tactics and designate the partner(s) responsible for each. Then explain how a newly empowered workforce across all three areas (if desired, or pick one) can come together to support and be held accountable for an expansion in affordable housing. Please also add your suggestions for how this plan could be financed. 4 https://www.fastcompany.com/90291860/this-healthcare-giant-invests-millions-in-affordable-housing-to-keep- people-healthy and https://www.mercurynews.com/2017/10/05/lifestyle-switch-more-bay-area-residents-are- choosing-to-rent-than-ever-before-and-theyre-paying-through-the-nose (accessed September 27, 2019) 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391885 (accessed September 27, 2019) PREPUBLICATION COPY: UNCORRECTED PROOFS
78 WORKFORCE FOR POPULATION HEALTH IMPROVEMENT 3 FOOD SECURITY/HEALTHY FOOD Food security is a health issue in Ourtown, USA, population 750,000. About 1 in 5 children live in a household that has difficulty getting enough food and especially obtaining fresh produce. The city has also lost a grocery store, which has left one area without reliable access to fresh food options. Associated with this challenge, city residents experience an obesity rate higher than in the average American city. The major local community nonprofit convened a group of stakeholders/partners to discuss the issue and consider the options for strengthening the local food environment to tackle both food insecurity and poor health outcomes associated with obesity. (For example, the local school district has not adopted the community eligibility provision of Title I [of the Every Student Succeeds Act]), which would reduce the administrative burden on school with low- income students who would benefit from free and reduced-price breakfast and lunch. To implement a healthy food environment strategy, the partners assembled identified some areas where communication, orientation, and training could equip all types of workers with knowledge and skills to advocate and take action in ways that can help address this community need. The group called for a comprehensive food security/healthy food plan. Please describe workforce strategies and tactics and designate the partner(s) responsible for each. Then explain how a newly empowered workforce across all three areas (if desired, or pick one) can come together and be held accountable in support of this effort. Please also add your suggestions for how this plan could be financed. Fill in the table based on your discussion, and choose someone to report back. PREPUBLICATION COPY: UNCORRECTED PROOFS
APPENDIX D 79 Small group worksheet (to be completed by scribe and read by the facilitator/rapporteur) Issue: Convener(s): Partners: Approach: (may leave blank) Strategies Tactics Responsible partner 1. 2. 3. 4. PREPUBLICATION COPY: UNCORRECTED PROOFS