San Luis Valley Public Health Partnership

Description

The San Luis Valley in southern Colorado is a geographically isolated area. Its 80,256 square miles include 3 rural and 3 frontier counties. Because Colorado's public health system is decentralized, each of these counties is served by a local health department with their own board of health. In order to optimize resources and staff, leaders of the 6 counties' health departments formalized a cross-jurisdictional sharing (CJS) partnership in 2013.

The San Luis Valley Public Health Partnership (SLVPHP) serves as a coalition of San Luis Valley's local public health directors. By collaborating to build capacity, their mission is to develop and sustain public health systems to improve health outcomes throughout the valley.

SLVPHP methods include sharing projects and staff when needed, working together to meet state planning requirements, and offering support and technical assistance to community coalitions. To standardize their partnership, they developed common guiding principles and an operating agreement. Every 3 years, county commissioners approve an inter-governmental agreement affirming the counties' support of these shared activities.

The SLVPHP is made up of the following public health departments:

• Alamosa County Public Health Department
• Conejos County Public Health and Nursing Service
• Costilla County Public Health Agency
• Silver Thread Public Health District on behalf of Mineral County
• Rio Grande County Public Health Agency
• Saguache County Public Health Department

The Colorado Department of Public Health and Environment (CDPHE) and the West Central Public Health Partnership (WCPHP) provide guidance to SLVPHP.

In 2013, SLVPHP was one of 16 sites across the country to participate in a learning community and develop models for cross-jurisdictional sharing through the Center for Sharing Public Health Services (CSPHS). This was a national initiative managed by the Kansas Health Institute with funding from the Robert Wood Johnson Foundation. Additional funding and support continues to be provided by the Colorado Department of Public Health and Environment's Office of Public Health Practice, Planning, and Local Partnerships (previously known as the Office of Planning, Partnerships and Improvement).

Services offered

This collaborative model has allowed SLVPHP to support each public health department in their responsibilities and new initiatives that benefit the group. SLVPHP shares services and functions, including:

• Emergency preparedness and response planning and staff
• Epidemiology including the investigation of tuberculosis, salmonella, rabies, food-borne illnesses, as well as the prevention of HIV and childhood lead exposure.
• Child fatality reviews
• Home health services
• A breastfeeding coalition
• A regional environmental health program (retail food safety, recreational water inspection, and institutional inspections)

The partnership serves as a forum for exchanging information and exploring new ideas. Partners meet monthly to review current projects, hear presentations from subject-matter experts and community partners, and explore new opportunities for sharing information and services.

Results

• Prior to the partnership, environmental health services were provided by the state. SLVPHP implemented a regional environmental health program that made it possible to deliver services catered to the local priorities in the region.
• SLVPHP obtained funding in 2016 from the Colorado State Innovation Model to improve access to care and reduce behavioral health stigma over a 3-year period. Funding supported a public education campaign and the integration of behavioral health into primary care settings.
• In 2018, for the first time, the 6 public health agencies developed a shared regional community health assessment and public health improvement plan, published in January of 2019.

SLVPHP received the National Health Security Award from the National Association of County and City Health Officials (NACCHO) acknowledging their creation of a regional disaster health response system. This award was given to 6 health departments that have implemented various health security-related initiatives.

Challenges

Recruitment and retention is a common problem in rural areas, and turnover of program directors is especially disruptive to operations. The partnership is an additional support system for new directors, significantly shortening their learning curve.

With limited staff, time, and resources, the partnership is cautious about how many projects they take on. Funding from the Preventative Block Grant through the Colorado Department of Public Health and Environment supports a part-time partnership coordinator position. A lack of sustained full-time funding impacts SLVPHP's capacity to develop new initiatives and to work upstream to address health equity issues.

A state initiative to modernize public health funding is underway. Planning and capacity analyses consumed a substantial amount of time in 2019 across agencies.

Public communication has had challenges. Some areas of the Valley have less than adequate wireless access, and no single media outlet reaches all citizens.

The article Board of Health Hears Local Issues, published in the Valley Courier, shares more on barriers experienced by SLVPHP and their partners.

Replication

For more information about the program, the Center for Public Health Sharing includes the following information specific to the San Luis Valley Public Health Partnership:

• CJS case report
• Project description
• Lessons learned
• Summary report
• Site visit report
• Center's site summary
• Policies, procedure, tools, and reports produced by SLVPHP

CSPHS's CJS Resource Library for Rural and Small Jurisdictions contains research on best practices, case studies, and toolkits for rural jurisdictions considering or in the process of adopting CJS. The partnership has benefited from their tool Measuring the Impact of Cross-Jurisdictional Sharing in Public Health.

Contact Information

Emily Brown, Facilitator
San Luis Valley Public Health Partnership
SLVPHPFacilitator@alamosacounty.org